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' s�s-7aaoozo City of Zephyrhill Permit Application Fax-813-780-0021 <br /> � Bullding epartment <br /> Date Received <br /> � ��� Phone Contact for ermitting <br /> Owner's Name �2���- �I�%/ Owner Phone Mumber (�/✓' 12�1�'' ���/ <br /> Owner's Address � 7 � �T 0��� � Owner Phone Number <br /> Fee Simple Titleholder Name Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS .�C� 7 � �7 � � /� • � LOT# � <br /> SUBDIVISION PARCEL I # �� D��O D �OO O�� <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED e NEW CONS7R B ADD/ALT 0 SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE Q SFR Q COMM 0 OTHER <br /> TYPE OF CONSTRUCTION Q BLOC � FRAME 0 STEEL Q <br /> DESCRIPTION OF WORK (/ � .e /7T CcC�G �I// �, X�S�"1� <br /> BUILDING SIZE SQ FOOTAGE HEIGHT <br /> OBUILDING $ VALUATION TOTAL CONSTRUCTION <br /> QELECTRICAL $ AMP SERVIC 0 PROGRESS ENERGY Q W.R.E.C. <br /> QPLUMBING $ <br /> 1 5�� <br /> �CHANICAL $ VALUATION F MECHANICAL INSTALLATION � � <br /> s�a o� <br /> . � � I <br /> QGAS Q ROOFING Q SPECIAL: � OTHER �r`�, <br /> � ��� / <br /> FINISHED FLOOR ELEVATIONS FLOOD Z NE AREA QYES NO � <br /> BUILDER COM ANY <br /> SIGNATURE REGI RED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> ELECTRICIAN COM ANY <br /> SIGNATURE REGI TERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> PLUMBER CO ANY <br /> SIGNATURE REGI TERED Y/ N FEE CURRE� Y/N <br /> Address icense <br /> MECHANICAL CO PANY . <br /> SIGNATURE ��S � � C Q� REGI TERED / N FEE CURRE Y/N <br /> Address /�2a, �GW �Q/ ,QQ . � � S �icense# <br /> OTHER CO PANY <br /> SIGNATURE REGI TERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set o Energy Forms;R-O-W Permit for�ew construction, <br /> Minimum ten(10)working days after submittal date. Re uired onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facflities 8 1 dumpster;Site Work Permit for su divisions/large projects <br /> COMMERCIAL Attach(3)complete sets of Building Pians plus a Life Sa ty Page;(1)set of Energy Forms.R-O-W Permit for new constructfon. <br /> Minimum ten(10)working days after submittal date. Re uired onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Faciflties 8�1 dumpster.Site Work Permit for all new proJects.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> ""'PROPERTY SURVEY required tor all NEW construc on. <br /> Directions: <br /> Fill out applicatlon completely. <br /> Owner&Contractor sign back of application,notarized <br /> If over 52500,a Notice of-.Co,rpmencement,is..required.=�.(AIC upgra es over 57500) <br /> *• Agent(for the contractor);or Power of Attomey;(for tFie oitinet)�would b someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERM�ITTING „�;�;: ,(Front oftApplicatipn ORIy);? � <br /> Reroofs if shingles Sewers+ ��� •Service�Upgrades A/C':,:';�. Fences( lot/Survey/Footage) <br /> a�.�,a_� .._�..._.�...,�.. .� .. .... .. ....... . <br /> Driveways-Not over Counter if on public roadways..needs ROW <br />