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sasasa-oa2o City of Zep yrhills Permit Applicatian Fax-813-780-0021 <br /> uilding Department <br /> Date Rsc�ived ' � <br /> Phone Con ct#or Permitting t <br /> Owner's Name I•�G G"(Q s Owner Phone Number �.3 fJ�✓ ! �a <br /> Owner's Address lY.�Crai�' �1t„ � q Owner Phone Number � � <br /> Fee Simple Tittehotder Name Owner Phone Number �- � <br /> Fee Simple Titleholder Address <br /> JdB ADDRESS ��'/ 2- a� �"!1J� LQT# �____� � <br /> SUBDIVISION � � P EL!Q# <br /> (OBTAINED FROM PROPERTY TAX NOTICE) <br /> WORK PRQPQSED NEW CONSTR AD A�T 0 S1GN Q Q DEMOZtSH <br /> INSTALL 8 REP IR <br /> PRQPQSED USE Q SFR Q GQ M [� OTHER <br /> TYPE OF CONSTRUCTION Q BLOCK Q FRA E � STEEL Q <br /> DESCRtPTtON OF WORIC d t✓2 ,�l /'/G� 'rS <br /> Bt11LDING S12E �� � SQ FOOTA�E HEIGNT ��� <br /> �gU«d��� I"5_____� VA�UATI N OF TOTAL CONSTi2UCTtON <br /> L �.a <br /> �ELECTRtCAL $ �r�� ANtP 8EF2 CE Q PROGRESS ENERGY Q Vtt.R.E.C. � <br /> QPLt)MBING �> � <br /> OMEGNANlCAl. �;� VAl.t1AT! N QF MECNANtCAI INSTA�I..ATION <br /> QGAS Q ROpFENG Q SPE IALTY 0 OTHER <br /> FINISHED FLOOR ELEVATIONS � � FLO D ZONE AREA QYES NQ <br /> BUII.dER QMpANY <br /> SIGNATURE R GISTERED Y/ N FEE CURRE� Y!N <br /> Address License# �` � <br /> .... � �.~-- I3 <br /> ELECTRICIAN �� � C MPANY �/'T� � i'YC <br /> SIGNATURE _ 12 GISTEFtED Y/ N FEE CURRB� Y/N <br /> Address .� t"} ,�7 �i� License# �1.3(�C�/ ,��� <br /> P�UMBER C MPANY <br /> 51GNATURE R GISTERED Y/ N FEE CURRE� Y/N <br /> Address Ucense# �- � <br /> MECHANICAL C MPANY <br /> 51GNATURE R GISTERED Y/ N FE6 CURRE� Y/N <br /> Address License# �- �� <br /> -_. ,-, r. <br /> _. ,. .,.__ , - , <br /> DTHER . , , - G MPANY �.. . ,� - ,,":.,.� <br /> 51GNA7URE RE ISTEREO Y/ N FEE CURRE� Y/N <br /> Address License# �� --� <br /> 2ESlDENTlAL Attach(2}Pfot Flans;(2}sets of Building Plans;{1}set o#Energy Fatms;R-Q-W Permit for new constructian, <br /> Minimum ten(10}working days after submittat date. R quired onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, <br /> Sanitary Facilities&1 dumpster,Site Work Permit far ubdivisionsflarge projects <br /> �OMN2ERCtAL_ Aftaah{3}camplete sets af Sullding Pians plus a Life fety Page;{1}set af Energy Forms.R-O-W Permit for new canstrvctian. <br /> Minimum fen(10)working days after submittal date. R quired onsite,Construction Plans,Stormwater Plans w/Silk Fence installed, <br /> Sanitary Facilities 8�1 dumpster.Site Work Permit for II new proJects.All commercial requirements must meet compfiance <br /> St�N PERMIT Attach(2}sets of Engineered Plans. <br /> ""PROPER'TY SURVEY required for all NEW constru tion.' <br /> }irections: <br /> Fill out application completely. � <br /> Owner 8�Contractor sign back of application,notariaed <br /> If over�2540,a Notiae of Commencement is required. (AlC uqgr des over$T500) <br /> ` Agent(for the conUactor)or Power of Attomey(for the owner)would b someone with notarized letter from owner authorizing same <br /> }VER THE COUNTER PERMITfING {Front of Application Only} <br /> teroofs if shingles Sewers Service Upgrades A/C Fences PIoUSurveylFootage) <br /> Drtveways-Not aver Counter if an pubtic roadways..needs ROW <br />