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; s�saeo-oo20 • City of Zephyrhill Permit Application Fax-813-780-0021 <br />, *"' Building epartment <br /> IDate Received [ � C � n <br /> �`1 Phone Contact for ermittin �l� �`�a -- �l��� <br /> Owner's fdame I �e- ��� TT�-'n��--� Owner Phone fdumber <br /> Owner's Address ��1� `'1T� �� Z'1'\\��`� ��l puvner Phone Idumber <br /> Fee Simple Titleholder Mame Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS � 1 1� "l � �� �� �f�,l. i(1'\ ��5 F�- �J�`l a- LOT# � <br /> SUBDIVISIOtd PARCEL I # � 1 ��� ��1'wl v-��W `�� `,Q� <br /> (OBTAINED FROAA PROPERTY TAX NOTICE) <br /> WOR6f PROPOSED � NEW CONSTR 8 ADD/ALT [� SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE - Q SFR Q COMM [� OTHER <br /> �1/PE OF CONSTRUCTIOM Q BLOCK Q FRAME � STEEL Q <br />� DESCRIPTIOId OF!lVOR6f ��e-� ~`��'�- (`-�C..p` C�.(���'� <br /> BUILDItdG SIZE SQ FOOTAGE HEIGHT <br /> QBUILDING $ VALUATION O TOTAL CONSTRUCTION <br /> ELECT A <br /> Q RIC L $ AMP SERVICE 0 PROGRESS ENERGY W.R.E.C. <br /> � <br /> �PLUMBING $ � � � �r�{ <br /> l� \ <br /> QMECHANICAL $ VALUATION O MECHANICAL INSTALLATION °' � <br /> OGAS Q ROOFING Q SPECIAL � OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD Z NE AREA �YES NO <br /> BUILDER COM APIY <br /> SIGidATURE REGIS ERED Y/ N FEE CURRE� Y/N <br /> Address - License# <br /> ELECTRICIAN COM AfdY <br /> SIGIdATURE REGI RED Y/ N FEE CURRE� Y/N <br /> Address License# � <br /> PLURflBER � W`''�'�"� COIIA AMY 'e-{�'�\5 1����\0.°�1S , I n�. <br /> SIGfdATURE REGI TERED Y N FEE CURRE� N <br /> Ac9dress �'J1l�J �`��� S� Z�'1\��5���-- ?J��-` License# c� �y a���a <br /> IViECHARIICAL CO PANY <br /> SIGRIATURE REGI TERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> OTHEPt CO P611dY <br /> SIGRlAYURE REGI TERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> RESIDEtdTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set o Energy Forms;R-O-W Permit for new construction, <br /> Minimum ten(10)working days after submittal date. Re uired onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> - ---� - - - Sanitary Facflities&=1-dumpster;Site Work-Permitior su divisionsAarge projects � - --�- -- - - �- — - �-- - <br /> COMii�iERCIAL Attach(3)complete sets of Building Plans plus a Life Sa�ety Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)working days after submittal date. Re uired onsite,Construction Plans,Stormwater Pians w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Permit for alllnew proJects.All commercial requirements must meet compliance <br /> SIGR1 PERMIT Attach(2)sets of Engineered Plans. � <br /> """PROPERTY SURVEY required for all NEW construc�lon. <br /> Directions: <br /> I Fill out application completely. <br /> Owner&Contractor sign back of appiication,notarized <br /> If over$2500,a Notice of Commencement is required. {A/C upgr des over 57500) <br /> `" Agent(for the contractor)or'Power of A�torney(for the owner)'voould b someone with notarized letter-from owner�authorizing same �• ,- . ' <br /> O!/E9t THE COUNTER PERMITTING - .(Front of Applica4ion:Or(ly) � - � • � <br /> Reroofs if shingles Sewers Seniice Upgrad'es A/C:: ,'Fences QIoUSurvey/Footage) ' , �� ` <br /> .�,•.;,.._ :.. ._ .. .� :; .:.,.,, ; ._ ,_ ,.,.- �,,.� <br /> Driveways-Not over Counter if on putilib�oadways..needs ROW <br />