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i <br /> 813-780-0020 City of Zep yrhills Permit Application Fax-813-780-0021 <br /> uilding Department <br /> Date Recelved � ` 1a p Phone Con act for PeRmitting 8 3 — � <br /> Owner's Name 0.� S'r�-S Owner Phone Number S�3 �(�8' �T��( <br /> Owner's Add�ess 3g olg �We�ade�, (pa� Owner Phone Number <br /> Fee Simple Titleholder Name Owner Phone Number <br /> I <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS 3g��0 �U.��MGC� �i" LOT# d J <br /> SUBDIVISION (k 11 P CEL ID# �Ll- ac - �. d 0 "o�DVO ` �3 U / <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED � NEW CONSTR e A D/ALT 0 SIGN Q Q DEMOLISH <br /> INSTALL R PAIR <br /> PROPOSED USE Q SFR Q C MM 0 OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q F ME 0 STEEL Q <br /> DESCRIPTION OF WORK �HS�all 7� U �ce X � (�►t � lD, k yt � �P,S• <br /> BUILDING SIZE SQ FOOTAGE HEIGHT <br /> OBUILDING $ p VALU ION OF TOTAL CONSTRUCTION <br /> In.Lil <br /> QELECTRICAL $ AMP S RVICE 0 PROGRESS ENERGY Q W.R.E.C. <br /> QPLUMBING $ <br /> �MECHANICAL $ VALU TION OF ECHANICAL INSTALLATION <br /> �' l`��°`� <br /> QGAS Q ROOFING Q S ECIAL 0 OTHER <br /> FINISHED FLOOR ELEVATIONS F OOD ZONE AREA QYES NO <br /> BUILDER � COMPANY � <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> I <br /> Address , ���j �y�e�k'#1 <br /> I <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> i <br /> Address I License# <br /> I <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> I <br /> Address I License# <br /> MECHANICAL COMPf4NY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> i <br /> Address I License# <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> i <br /> Address I License# <br /> � <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans; 1)set of Energy Forms;R-O-W Permit for new construction, <br /> Minimum ten(10)working days after submittal d te. Requ'ired onsite,Construction Plans,Stormwater Plans w/Silt Fence instalied, —"-- <br /> Sanitary Facilities&1 dumpster;Site Work Pe it for subdivisions/large projects <br /> COMMERCIAL Attach(3)complete sets of Building Plans plus Life Safet�jr Page;(1)set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)working days after submittal d te. Reqwred onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work Pe it for all new projects.All commercial requireme�ts must meet compliance <br /> SIGN PERMIT Attach(2)sets of Englneered Plans. � <br /> ""'PROPERTY SURVEY required for all NEW nstructio�. <br /> Directions: <br /> Fill out application completely. <br /> Owner 8�Contractor sign back of application,notarized <br /> If over$2500,a Notice of Commencement is required. (Al upgrades over$7500) <br /> " Agent(for the contractor)or Power of Attomey(for the owner) ould be someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Application O ly) <br /> Reroofs if shingles Sewers Service Upgrades A/C ences(PIoUSurvey/Footage) <br /> Drlveways-Not over Counter if on public roadways..needs RO <br />