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1 I�� <br /> ; • isas-7ao-oozo City of Zephyrhill Permit Applicatian Fax-813-780-Q021 <br /> Building Departmertt �'r� lf'"77'� <br /> ; <br /> Date Received <br /> Phone Conta t far Permitting -- <br /> •�. �� i <br /> .ac's Name ��L1. �- ��?r.l�- Owner Phane Plumber ��?� j - �I�� <br /> Owner's Address �c�. `� �, ' �"�,�, z. t Owner Phone Number <br /> Fee Simple 7itleholder Name Owner Phone lVurnher � � <br /> Fee Simpie Titleholder Address � 1 <br /> ,iOB ADDRESS tt?� 7 ��f LOT# 'a <br /> 4ue�ivisia� ��-�'1� ��il) � p,a�c��i�# �2�Z6- Z �t5"w�3- uvJ�l - J <br /> � (OBTAINED FROM PROPERTY TAX N07IC�j <br /> WORK PROP05ED NEW CONSTR A D/AL.T �J SIGN Q MOVE � DEMOC.ISH <br /> e INSTAL� � R PAIR <br /> pRQPOSED USE � SFR � C MM Q OTHER �-Q. <br /> 7YPE OF CONSTRUCTION Q BLOCK, � F AME � S1"EEL � C7THER ��l��{ <br /> pESCRIPTION OF WORK "� � YZ�r�c�C '� ��iG- Z.'� <br /> BUiL.DING SIZE ��� SQ FOOTAGE HEtGNT ^,_, <br /> �it�S9a�L C�84119�@aNF�d�B�¢4l0�°c lmii i�6C�P��IIlepA8�lW11�J0l98BAM9NlI&Y�lMAU�9ldtl�IIRA0INlIIl9 i "p � n p9,qp NI�IIN41� �iY9�I�IhuM9110MBtl0�90�BP�fi19!�@ <br /> �� BUlLDlNG �� � VALU TiON OF TOTAL Ct3NSTRilCTION <br /> I =.> ca"Z� ��`�� . <br /> � �LECTRIGAL. ($ � AMP SERVlCE � PROGRESS ENERGY Q W.R.E.0 <br /> � <br /> ��) PLUME3ING {$ - � <br /> � <br /> � MECHAHIGAL �$ � VALU T10N OF MECHANICAL INSTALLATIQN <br /> 1 <br /> � GAS � ROOFING � �PECIALTY Q OTHER <br /> FlNiSFiED FLdOR ELEVATIONS � � 1.00D Z(7NE AREA DYES �NO <br /> E�9 ° '�' p � �� ��fl��Q� <br /> BUILDER ! COMPANY ��� Vc�4" tl(au�k1�[L_� c <br /> SIGNATURE �r� REGtSTERE4 {�/�FEE Ct1Rft NT Y N � <br /> Address j�J��� („�5 �r �e CI �� c3 �J License# i(,,,�, �,j"���iJ;,i�,� <br /> ELEC7RICIAN COMPANY <br /> SiGNATURE REGISTEftED Y 1 N FEE GURRENT Y i N <br /> Address License# �— I � <br /> P1.UMBER COMPANY <br /> . SIGNATURE REGISTERED Y/ N � FEE CURRENF Y 1 h! <br /> Addrass License# � � <br /> Pn�CHANlCAL COMPANY <br /> �NATURE REGISTERED Y I N FEE CURRENT Y/(LI <br /> Address I..s"cense# �� � <br /> . ��.— <br /> OTNER COMPANY <br /> $1vi3HTURc REGI,ri',"ERcD � Y i �t � FEE CURP.�NT Y/N ' <br /> Address License# � ! : <br /> � � <br /> RESIf1Ehl'FIAL. Attach{?�Plot Plans;(2)sets of Building Plans;(1) et of�nergy Forms <br /> Minimum ten(1 Qj working days after submitta(date. Required onsite,Construction Plsns,Sanifary Facilities&1 dumpsfPr <br /> CONiNfERCtAt. Atfacfi(3}sets af Building Plans;(1}set af Energy rms. <br /> Minimum ten{10)working days after submitta!date. Required onsfte,Construction Plans,.Sanitary Facilities&1 dum�ster <br /> AU commercial requirements must meet compliance ` <br /> 51GN PERNIIT Attach(2)sets of Engineered Plans. <br /> *"**PROPERTY SURVEY required for a1l NEW con trucfian. <br /> -w..� �6 �" _��a�..�9' � ' , gpoaaaW �Prpkm�a�;;�11p9 <br /> rections: <br /> Fili out application completely. <br /> Owner&Cantractar sign back af application,natarized <br /> !f over$2500,a Notice of Cnmmencement is required. (A/C upg ades over$5000) <br /> " Agent{far the contractor)or Power of Attorney,(for the owner)would be someone with notarized letter from owner authorizing same • <br /> OVER 7HE COUNTER PERMIITlNG (Frant of Applicafian Only) <br /> Reroafs 6ewers Service Upgrades A/C Fences(PIoUSurvey/Footage) <br /> Driveways-Nat over Counter if on pubiic raadways..needs ROW <br /> r�,5�� <br />