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. • � ais-�aaoozo City of Z phyrhills Permit Application Fax-813-780-0021 <br /> ` Building DepaRment <br /> Date Received Phone ontact for Permitting <br /> Owners Name 1�/ Owner Phone Number "'� I� <br /> Owner's Address I V Owner Phone Number <br /> Fee Simple TiUeholder Name Owner Phone Number <br /> Fee Simple Titleholder Address <br /> JOB ADDRESS D 1 1 f f ✓J J � LOT# � <br /> SUBDIVISION Q PARCEL ID# ' — - V <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PROPOSED e NEW CoNSTR� ADD/ALT 0 SIGN Q Q DEMOLISH <br /> INSTALL REPAIR <br /> PROPOSED USE � SFR Q COMM Q OTHER <br /> TYPE OF CONSTRUCTION BLOCK Q FRAME Q STEEL Q <br /> DESCRIPTION OF WORK � ��(�f <br /> BUILDING SIZE SQ FOOTAG � HEIGHT � -S)7_Q,;�cSL 7�.' <br /> ��,.,r TrTTrT �,—�T�,—�� y <br /> �BUILDING $ �� VA UATION OF TOTAL CONSTRUCTION ��� <br /> � � <br /> QELECTRICAL $ AM SERVICE Q PROGRESS ENERGY Q W.R.E.C. IV�� <br /> QPLUMBING $ � ��� <br /> ; <br /> V N���c�- � <br /> OMECHANICAL $ VA UATION OF MECHANICAL INSTALLATION <br /> QGAS Q ROOFING Q SPECIALTY 0 OTHER � � • � � � � ��{'�'` <br /> , -�� �� CS <br /> FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NOT��^�(',�, � <br /> �.�.-.-...r....�...r...r��C-F� ..-r C-F�' •...�:-F� \�/r.-.- <br /> BUILDER - C MPANY SvU'�'l ! � ? !" <br /> SIGNATUR REGISTERED Y/ N FEE CURRE� Y/N <br /> Add s � License# <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address � License# <br /> PLUMBER COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> MECHANICAL COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> OTHER ' COMPANY <br /> SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N <br /> Address License# <br /> IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Pla ;(1)set of Energy Fortns;R-O-W Pertnit for new consUuction, <br /> Minimum ten(10)working days after submitt date. Required onsite,Construction Plans,Stortnwater Plans w/Silt Fence installed, <br /> Sanitary Facilities 8 1 dumpster,Site WorMP rtnit for subdivisions/large projects <br /> COMMERCIAL Attach(3)complete sets of Building Plans plu a L'rfe Safety Pape;(1)set of Energy Fortns.R-O-W Permit for new construction. �i <br /> Minimum ten(10)working days after submitt date. Required onsite,ConsVuction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster.Site Work P rtnit for all new projeds.All commercial requirements must meet compliance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> ""PROPERTY SURVEY required for all NE construction. <br /> .�1..�1-1..{-• •....-F:-FI-��f-1-f-F�i-I..�I..FI-1..1- 1-F�1-�1-��4i-1�-.1-4.�-.4-1..E•I..FI..1-FFFFI..f-F.�F-FF-F.1-1..F.F- <br /> Directions: <br /> Fiil out application completely <br /> Owner&ConVactor 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 Attomey(for the owne)would be someone with notarized letter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Applicalion nly) <br /> Remofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage) <br /> - Driveways-Not over Counter if on public roadways..needs OW <br />