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813-780-0020 City of Zephyrhill Permit Application Fax-813-780-0021 <br /> Building epartment <br /> Date Received ��-°s�� phone Contact for ermitting p �3�j - ��Q <br /> Owner's Name f�n � / O F Owner Phone Number ��'� 3C/� " � <br /> 3+ • <br /> Owner's Address o7i l S (i�Ls.S /`�Q, S�4✓�}M1jA� Owner Phone Number <br /> Fee Simple Titleholder Name Owner Phone Number <br /> Fee Simple T(tleholder Adda�ss � � <br /> � <br /> JOB ADDRESS ��c,� �� �. LOT# 6 � <br />_ SUBDIVISION _ —_ _ _- PARCEL 1 # ���a�-a i��lo�/SSQQ-=('��o�---- — - - <br /> � (OBTAINED FROM PROPERTY TAX NOTICE) � <br /> WORK PROPOSED B N TALLSTR� REP AL�T 0 SIGN Q Q DEMOLISH <br /> PROPOSED USE Q: SFR Q COMM 0 OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q <br /> DESCRIPTION OF WORFf �I�CeOF d J� � �rx� , •�-G� C�Ltt'P-�P�I,� Qr1+B�5 �ZG-Iy3-L, �Ja <br /> BUILDING SIZE SQ FOOTA►GE o�LO�� HEIGHT <br /> QBUILDING $ /�QO VALUATION O TOTAL CONSTRUCTION <br /> (O <br /> QELECTRICAL $ AMP SERVIC Q PROGRESS ENERGY Q W.R.E.C. <br /> QPLUMBING $ Q_�r <br /> ��O <br /> QMECHANICAL $ VALUATION O MECHANICAL INSTACLATION � \ <br /> QGAS � ROOFING Q SPECIAL Y 0 OTHER <br /> FINISHED FLOOR ELEVATIONS FLOOD Z NE AREA QYES NO <br /> BUILDER COM ANY <br /> SIGNATURE REGIS ERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> ELECTRICIAN , COM ANY <br /> SIGIdATURE REGIS RED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> PLUMBER - COM ANY <br /> SIGNATURE REGI ERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> MECHANICAL COM ANY <br /> SIGMATURE REGI TERED Y/ N FEE CURRE� Y/N <br /> Address License# � <br /> OTHER �0�� CO PANY /��L� C.��� ��C� <br /> SIGNATURE REGI TERED Y/ N FEE CURRE� Y/N <br /> Address y 3r�cs %�`G �Z Y✓ License# �� � <br /> RESIDENTIAL 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,ConstrucGon Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities 81 dumpster;Site Work Permit for su divisions/large projects <br /> COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Sa ty 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 Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Permit for all ew projects.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> ""PROPERTY SURVEY required for all NEW construct on. <br /> Directlons: -. <br /> Fill out application completely. '` . t <br /> Ovmer&Contractor sign back�f application;'notar(zed-�-���,----••�--:;�; <br /> !,r �.,_ <br /> If over 52500,a Notice of!Comnne�cement is required:;;;�(A'/�_uqgra es over 57500) <br /> � �• l.. 1,�.�:�:;'�Il:i.1�; �,: (.1� ,��t <br /> "" Agent(for the contractor)or Pa�yer,.qf,�Attomey,,(forthe oYim��);(�!Qu�d'be someone wlth notarized letter from owner authorizing same <br /> . ..-. i� ,.. -.I.�.:'i` :::W:: � <br /> OVER THE COUNTER PERMITTING,';;`,1�(Fronf ofApplication�Only),� � <br /> Reroofs if shingles Sewers Service Upgrades A/�W Fences( Iot/Survey/Footage) <br /> Driveways-Not over Counter if on public roadways..needs ROW <br /> � <br />