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��3'7$°-��'� C6ty of Zepltyr i11s Permit Application Fax-813-76D-p021 <br /> Buil ing bepartment <br /> IDate Received � r� <br /> � Phane Gontact for Permittin 3 p� �s�$ ._ ��p�a <br /> ti <br /> Qwner's Mame Cq,r /�Y�oi,h,uC � � � � Owner Phone Rlumber <br /> Oevner`s Address �L�o� 1.o cJ'�'�'�, �j-�� Ovyrter Phane Mumber �— �� <br /> �ee SFntple Titieflolder t�ame av�tner Phone�lumber �� � <br /> Fee Simpte Titleholder Address <br /> , �o��►o���ss �Gt 2 5�l�. S`�. �a�� <br /> ( sue���flStaN � � PARC L tD# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> ' HNf�ftEf PROP08EQ NEW CoNSTR ADD/ LT � SIGN � Q DEMpLtSH <br /> iNSTALL 8 REPAI <br /> '' �ROPOSED U5E ,Q �SFR �J CQM � OTHER <br /> I <br /> I TY���?F CONStRUCi'#t3M Q S�OCK Q FRAM �'� STEEL Q <br /> tl�S�RFPTIOid CtF V�OR!{ �` �L ��.� l C�� �'4�1i' ��}'� Ar�1`���... �t�t`s:. 2„-��� �.t.+:R.E <br /> BUtL�lMG Sl�E � � St�FOOTAGE tlEtGFIT' ��� <br /> QBUILDlNG $ VALUATIQ OF TOTAL CONSTFtUCT10SU <br /> � � <br /> �ELECTRICA� $ f �D '��-j AMP SER ICE � PROGRESS ENEf2GY � W.R.E.C. <br /> �9� <br /> QPLUM8ING � � <br /> QMECHANICAL. $ VALUA710 OFMECHANICRI.INSTALLATIOl� � l � �� � <br /> QGAS � ROOFING Q SPEC i41.'1'Y � QTHEF2 <br /> FINISHED FL0012 ELEVATIONS � FLC10 ZONE AREA QYES NO <br /> �U1LDE12 C MP/4NY <br /> SIGRIA7'URE R GISTERED Y/ N FEE CURRE� Y/N <br /> Ac�dress License# _� C. 1�C3%��-�� � <br /> �ILECl'RlCIAi� � ^ C MRA[�Y t94'Y�Q . S ' LFJ <br /> SIGtdATURE R GISTERED Y I FEE CURRE� Y/N <br /> �4ddress �icense# �� � <br /> PLUla(BER C MPAMY <br /> S1GMA'TIJRE R GIS7ERED Y I N FEE CURRE� Y f N <br /> Address License# �i � <br /> MEGNAIVICAL C MPANY <br /> SIGRIATURE R Gt57ERED Y J N FEE CURRE� Y i M <br /> Address License# �— � <br /> OTfiER OMPANY <br /> SIGMATtiRE R GI3TERED Y/ N FEE CURREP Y 1 N <br /> Addr�ss �(cense# �� <br /> RES1DEt�TtAL Attach{2)Plot Plans;(2j sets of Buttding Pfans;(1)s t of Energy Forms;F2-O-W Permit for new construction, <br /> Minimum ten(10}working days after submittal date. equired onsite,Construcfion Plans,Stormwater Ptans w!Silt Fence instailed, <br /> Sanitary Facllities&1 dumpster;Site Work Permit fo subdivisionsllarge projects � <br /> CUtNi1UtE�2CtAL Attach(3}complete sets of 8uild(ng Pians pius a t.ife Safety Page;{1)sek of Enetgy Forms.ft-C7-W Permit for new construction. <br /> Minimum ten(70)working days after sabmittat date. equired onsite,Canstruction Plans,Stormwater Pians w1 Siit Fence instaHed, <br /> Sanitary Facilities&1'dumpster.Site Work Permit fo all new projects.All commercial requirements must meet compliance <br /> SIG3�PEi2MIT Attach(2}sets�of Erigineered Plans. <br /> '•"PROPERTY SURVEY required for ait NEW cans ction. <br /> Directiv�ts: ' <br /> Fill out appiicatfon completely.. <br /> Owner 8 Contractor sign back of applicatian,notaNzed <br /> If ouer�2500,a Natice af Commencement Is required. {�51C up rades over�7340} <br /> •s r,t,-..: <br /> Agent(for the contr8cfor)"bYPower�of�Attomey(fo�.lhe owner)waul be someone with notarized letter from owner authorizing same <br /> :,r; .. , , , ., ,. -.; <br /> OltER THE COUNTER��,,ERMITTING..��.�.,,.;{Front,af Appticat€on'�Only) <br /> Reroofs if shingles Sewers „r,,; �;Seniice�Upgrades�:A/C°'; Fenc s(PIot/Survey/Footage) <br /> .. . � .. .. , � <br /> E}riveways-Nat ovet�oun�et`if'6n`pabCic�toadways..n��ds FtoW <br />