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- - 3 <br /> �=u ;t <br /> , , s��aso-oo2a City of Zephyrhills ermit Appficatian Fax-813-784-4Q21 <br /> Buitding De artment <br /> Dat�Received <br /> Ahone Contact for Pe mitting — <br /> � p ➢ n@ 1 � B 1 t t 3 B <br /> Owner's�lame J''i t C�2��� �DJ'�` ��C � Owner Phone Mumber � �"��}�' y�� <br /> Owner's Address �,l�,l l U�� ��('�{.' Owner Phone Number `_---� �� <br /> Fee Simpie Titiehoider Name Owner Phone iVumber �.----.— � <br /> Fee Simpie Titfehoider Address - <br /> JOB ADDRESS �� !� t�� �/t ��i� LOT� �__� <br /> SUBDlVlSION � � PAftCEt 1 # <br /> (OBTAINED FROM PROPERTY TAX NOTiCEj <br /> WORK PROPOSED � NEW CONSTR� ADdlALT � S1GN � 0 DEMOI.iSFi <br /> INSTALL REPA4R <br /> PROPOSED USE �{ SFR � COMM � 07HER <br /> TYPE OF CONSTRUCTION 0 B�OCK � FRAME � S7EEL � <br /> QESGRlPTtQN OF WORK �� ���Yl- �U�` ��(1 / 1C�Gi.�i `� f <br /> BUILdING StZE �— � SQ FOQTAGE HEIGNT � <br /> �eU�LDiNG � —� VAL.UATION F TOTAL CONS7RUCT10N <br /> �ELECTRiCA� ��� AMP SERVIC � PROGRESS ENERGY � W.R.E.G. <br /> � <br /> OPLUMBlNG $ `� ����5 <br /> �MEGHANICAL $ � VALUATION OF MECHANICAL INSTALLATION � <br /> � `-�d Oa <br /> OGAS 0 120QFING � SPECI LTY �l dTHER <br /> FINISHED FLQQR ELEVATIONS r�� F�dQ ZONE AREA �YES NO <br /> Lc�1���� � t � <br /> � R �s'i!'"°!'�L�f+PT1���0"'R�Q••'1"'C'�C��°[�II�Pf�"C�'C'�U �'f�A�Pi'm.P'O�fmYR'�V'�'9° <br /> BUItDER � �� G iitiPAtVY <br /> SIGNATURE ( R GISTEAED Y/ N FEE CURRER Y 1 N <br /> Address License# �— � <br /> ELECTRICtAN � OMPANY <br /> S{GE�RTURE EGIS7ERED Y! N FEE CURRE� Y!N <br /> Address License# �-- � <br /> FLUMBER � OMPANY <br /> SIGl�ATURE l EGISTERED Y( N FEE CURRE� Y/N <br /> Address License# � � <br /> MECNANICAL GOMPANY !�{'� \(�°r'�--i, ��P���(a Y} L-�, <br /> SiGi3ATtlftE REGiSTERED N FEECURRER Y!N <br /> Address � (iJ �� l.icense�# �"v�'—'I$��1 I `Y � <br /> OTHER � � COMPANY <br /> SIGNATURE ( 4 REGIS7EREb Y I N FEE Cl3RREP Y!IV <br /> Address license# � � <br /> B6ee � tlSqR � 1l8B8111@lIIA ➢ 40I � 8i � � 686ti161 � 66@Bi ! l8Ip8116II � I1 � DtE � H4t <br /> RESIDENTIAL Aitach(2}Piot Plans;(2}sets of 8uilding Plans,O set of Energy Forma,R-O-W Permit far ne�n!canstruction, <br /> Minimum ten(14)worlcing days after submittai d e. Required ansike,Gonstruction Plans,Stormwater Plans w/SiiE Fence instai{ed, <br /> Sanitary Facilities&1 dumpster;Sile Work Perm t for subdivisionsliarge projects <br /> COMMERGIA� Attach(3)complete sets of Buiiding P4ans pius a�i4e Safety Page;{1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten{14)working days affer submittai d te. Required onsite,Construction Plans,Slarmwater P(ans w/Silt Fence instailed, <br /> Sanitary Facilities 8�1 dumpster.Site Worlt Per it for aI(new projects.A(1 commercia4 requirements must meet compliance <br /> SIGN PERMIT Attach(2)sats oF Engineered Pians. <br /> "*`*PRQPERTY SURVEY required for aII NEW onstruction. <br /> P b..L e� <br /> Directions: <br /> Fiii out appiication complekety <br /> Owner&Gontractor sign baok of application,notarized <br /> !f over$2500,a Notice of Commencement is required, ( G upgr�des over$7500) <br /> *' Agent(for the contractor}or Power of Rttorney(for the owner)would be someone wiih noiarized ietter from awner authorizing same <br /> OVER 7HE COUNTER FERNIITTING {Front af Application nly) <br /> Rsroofs if shingles Sewers Service Upg'rades RtC Fences(PloUSurveylFootage} <br /> Driveways-Not aver Gounter if on pub{ic roadways..needs R W <br />� <br />