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<br /> s��aaa-oozo City of Zep yrhills.Permit Application Fax 813-780-4021
<br /> uilding Department
<br /> �' M
<br /> Date Received Phane Con act for Permitting -
<br /> ,Awner's Name ,.,� L�'S � V \ Owner Phone Number �t 3�_I 1 -�d��
<br /> Owner's Address l�2�'1 C..P � GG (� I� Owner Phone Number �
<br /> Fee Simple Titleholder Name �— Owner Phone Number
<br /> I
<br /> Fee Simple Titleholder Address
<br /> �rJ l/�"1C�f�
<br /> �,..iOB ADDRESS � �7�t.p LOT# �__�
<br /> BUBDIVISION � � P CEL ID�
<br /> (OBTAINED FROM PROPERTY TAX NOTICE)
<br /> WORK PROPOSED e NEW CONSTR 8 A DlA�T � SIGN Q Q DEMOLISH
<br /> INSTALL X R PAIR
<br /> PRQPOSEQ USE � SFi2 Q C {UIM 0 OTHER
<br /> TYPE OF CONSTRUCTION Q BLOCK Q F ME � STEEL Q
<br /> t I
<br /> DESCRII'TION OF WORK r � tn�� S .
<br /> �
<br /> BUI�dING SlZE � � SQ FOOTA,raE HEIGHT �—�
<br /> BUt�DING � /"�/`, VA�U tON OF TOTAL CONSTRUCTION
<br /> lJ
<br /> �E�ECTRtCAL � � AMP S RVICE 0 PROGRESS ENERGY Q W.R.E:C.
<br /> �PLUMBlNG � �
<br /> QMECNANICA� � � VALU TIQN OF ECHANtCA�INSTA�lAT10N
<br /> OGAS Q RQQFING Q S ECIALTY � OTNEFt
<br /> FINISHED FLOOR ELEVATIONS ��� F OOD ZONE AREA �YES NO
<br /> BUILDER COMPANY �Q{!� �'j YtiLJ(f
<br /> SIGNATURE � � �,�,4,,.,v REGISTE�eo Y/ N FEE CURRE� Y/N
<br /> Address License# �� �
<br /> E[.ECTRICIAN COMPAINY
<br /> SIGNATURE ,, REGISTE�iED Y/ N FEE CURRE� Y/N
<br /> ,......, i
<br /> Address � License# � —�
<br /> P�UMBER COMP�
<br /> SIGNATURE REGIS7E�2ED Y/ N FEE CURRE� Y/N
<br /> Address ( License# � �
<br /> (
<br /> MECNANICAL COMPANY
<br /> 81GNATURE REGISTE�eo Y/ N FEE CURRE� Y/N
<br /> Address � License# � �
<br /> C}THER GOMPANY
<br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
<br /> , Address License# �— �
<br /> 12ESIDENTIAI Attach{2}Plot Plans;{2)sefs of Buitding Plans;( }set of Energy Farms;F2-4-UV Pennif for new canstruction,
<br /> Minimum ten(10)working days after submittai d e. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
<br /> Sanitary Facilities&1 dumpster;Site Work Perm t for subdivisionsRarge projects
<br /> CQMMERGIAL AttacFi(3)complete sets of Building Plans plus a ife Safe#y Page;(1}set of Energy Forms.R-O-W Pennit far new construction.
<br /> Minimum ten(10)working days after submittal d e. Required onsite,Construction Plans,Stormwater Plans w/5ilt Fence installed,
<br /> Sanitary Faoilities&1 dumpster.Site Work Perm t for alf new projects.A!I cammerciai requirements must meet compliance
<br /> SIGF!PERMIT Attach{2}sets af Engineered Plans.
<br /> '"*`PROPERTY SURVEY required for all NEW nstructiani
<br /> Directions:
<br /> Fill out application completely.
<br /> Owne�8�Contractor sign back of application,natarized
<br /> 1f over$2500,a Natice of Commencement is required. (Al upgrade�over$7500}
<br /> "" Agent(for the contractor)or Power of Attomey{for the owner) uld be someone with notarized letter ftom owner authorizing same
<br /> OVER THE COUNTER PERMIITING (Front of ApplicaUan Ont } , _ _,_ _,_ _ ., .. ,_..,. -., _...••.
<br /> Reroofs if shingles Sewers Service Upgrades A/C F nces(PIoUSurvey/Footage) , . . ' ' ,�
<br /> Driveways-Not over Counter if on public roadways::needs RO ' ' , . , ,,A, _ _ , • '
<br /> , „, ; • , ,. � . , � ,
<br /> , , � - . � .., , _ :< . .�a... .-,:. .��...,� .
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