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813-780-0020 City of Z phyrhills Permit App(ication Fax-813-780-0021 <br /> Building Department <br /> Date Received Phane ntact for Permitting -- <br /> _r-�_�,.._j_�-[.._[-i- <br /> Owner's Name Owner Phone Number ���-79�j� <br /> Owner's Address G�2 Owner Phone Number <br /> � � <br /> Fee Simple Titleholder Name ADELLE AMISO , Owner Phane Number � � <br /> Fee Simple Titleholder Address <br /> , � <br /> JOB ADDRESS ��]��,_�,__,_ �., �„_�,� __ LOT# _2� <br /> SUBDiVIS10N � SUNSET ESTATES 'i � PARCELID#�2-26-21-0300-00000-023� � ^� � <br /> (OBTAINED FROM PROPERTY TAX NOTICH) <br /> WORK PROPOSED e NEW CONSTR 8 ADDIA�T �� S[GN 0 � DE(VIOUSFE <br /> INSTALL REPAIR <br /> PR4POScD USE � � SFR � G01VIM ' � OTHER <br /> TYPB f.'�=CONST'RUCTION Q BLOCIS 0 FRAME � � STEEL Q <br /> DESCRIPTION OF WORK ' <br /> � <br /> BUIi.DtFlG SIZE � �� SQ FOOTAGE '( � HEIGNT [$'�L�LAI�L��jS�II <br /> YT`"1"'7T'1"'tTr1'TrTTT1'�1"TI"1"f�ITt'1"7T r"1'"7"'�"'1'�TI�TTIT�" R <br /> �B�`��,�� � 1 475 VAL AT10N OF TOTAL CONSTRUCT1dN <br /> �E�ECTRICAL $ AM SERVICE � PRQGRESS ENERGY � W.R.E.0 <br /> � <br /> �P��,��IN� � � I �`� � <br /> � �, � � <br /> �NCECHAN(GAL $ VA ATION iF MECHANICAL INSTAILATIQN <br /> �GAS � RdOFING Q SPEGIAI.i 1' � dTHER <br /> FINISHED FLOOR ELEVATIQNS FLOOD ZONE AREA �YES NO <br /> I <br /> � <br /> �-:--:�-ir-F-ir�:-���G-ir�fri-�:--i�i�'�--�' 3+-F:--i�i�-:�-0�:--:� ' i�i•�iri�-i�'+-i--e�i���r1�i--:-�i�f�+--:oi{��w+i--:-ir�-:-�:--i�:ri-F- <br /> BUILDER ., � � COMPANY ��:7't�.S�i3 s'i <br /> SIGNATURE � � REGISTERED / N FEE CURRE� Y/N <br /> Address �1�-� � License# �^ � <br /> i <br /> � <br /> ELEGTRtCtAN CQMPANY <br /> SIGNATURE REGISTERED Y/ N FEE GURRE� Y/N <br /> Address I License# �- � <br /> P�UMBER CdMPANY <br /> SIGNATURE REGISTEREp Y/ N FEE CURRE� Y/N <br /> I <br /> Address � � i License# � � <br /> � , <br /> � <br /> MECHANICAL CQMPANY <br /> SIGNATURE REGISTERED, _ Y/ N FEE CURRE� Y/N <br /> I <br /> Address � License# �- � <br /> � <br /> OTHER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> i <br /> Address � License# <br /> 11 ! ! l11I11I1lIII ! l1I111111111 I ! ! l�1111 ! l11111111111111 ! l111 ! l11ti1 ! <br /> RESIDENTIAL Attach t2}Plot P1ans;{2}sets af Bui(ding P(an ;{1}sef of Energy Forms;R-O-W Permi#for new construction, <br /> Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilitiss&1 dumpster;Site Work Pe it for sutidivisionsilarge prajects <br /> COMMERCtAL Attach(3)complete sets of Building Plans plu a Life Safety Page;t1}set of Energy Forms.R-O-W Permit for new construction. <br /> Minimum ten(10)working days after submittal date. R�quired onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster Site Work Pe mit for ali new projec#s.Ai1 commercial requirements must meet compliance <br /> SIGN PERMiT Atfach,(2)sets of Engineered Plans. � <br /> `""""PROPERTY SURVEY required for all NE construction. <br /> ! [ Y ] ■ � ! i 1 ��l�l�l�l�T�11�AT� ! ■f� ■ � • ■ l ■ ��l ' . I�r4�* *l�TT*lY9v�TrT�i� <br /> !�� <br /> Directions: � <br /> Fill out application completely � <br /> Owner&Contractor sign back of application,notarized <br /> If over$2500,a Notice of Commencement is required. ( C upgrades over$7500) <br /> "' Agent(for the contractor)or Power of Rttomey(for the owner would be�someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Application nly) � <br /> Reroafs if shingles Sewers Service Upgrades A/C Fences(PlotlSurvey/Footage) <br /> i <br /> Driveways-Not over Counter if on public roadways..needs R W i <br /> i <br />