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� s s e�aaeo-oozo, City of Z phyrhills Permit Application Fax-813-780-0021 <br /> , , � 8uilding Department � <br /> ' • ���,�.7- �,t�7_ <br /> � Date Received , Phone ontactforPermittin - �1 <br /> • Owner's Name. N �-� �/L �. Owner Phone Number �� "' 1 O�^��� � t�� <br /> , � Owner'sAddress �0��� ����`�£ ' `"'^'^"'�J.� zt�..t 3��`awnecPhoneNutnber C- � <br /> Fee Simple Tideholder Name A1 C, l.' �-- Qwner Phone Number <br /> � $t3-��o- �-tl �I� <br /> Fee Simple Titleholder Address , O`��p J E v E. oi�l�(,� �'Z- r�^^ �3 '�j ` <br /> JOB ADQRESS O'i`t �A ti+4 1rtil . ��Pti1 (tiLS r L' `���� I.QT# ��T�. y �� <br /> SUBOiViStON C +�' pt � PARCE�IQ# 0�.:�1P��-1� �o l O"'O7.�"�° .� "'"�a� 'Cr <br /> (OBTAINEO FROM PROAERTY TAX NQTICE) <br /> WORK PROPQSED � NEW CON57R ADD/ALT � SIC,N Q Q DEMOLISH <br /> IN3TALL REPAIR <br /> ~ PRQPOSED USE SFR COMM � OTHER <br /> TYPE OF CONSTRUCTION BLOCK FRAME � STEEL Q <br /> ' DESCRIP710N OFWORK Ro�2i F JR N n' �WE�"�°�"T�C tS� Tat+-+�� Q°4� � S�'�� ��'"ry5�'At"L^ <br /> BUILDiNG S1ZE 1 4 .7 a J � S4 FOOTAG 1��;.7 HE{GHT - `�.��O � t <br /> BUILDING $ 9 V LUATION OF TOTAL CONSTRUCTION <br /> q,o��.. <br /> QELECTRICAL �� A P SERVICE � PROGRESS ENERGY Q W.ft.E.C. <br /> �PlUMBING $�`'�OO.o O �j�(j,���^ <br /> � � � <br /> OMECHANlCA� �'.6 � V LUATION OF MECHANICAL INSTALLATION <br /> ` <br /> QGAS Q ROOFING Q SPECIALTY � OTHER <br /> F[NISHED FLOdR ELEVATIONS ��� _X�ST �LddD ZONE AREA QYES NO <br /> G f1� S F- ADA+IZ � ` i.i��MPANY �A�.t,.�G� t�'SoGt�'TE� �!-� C��I-�LE.'� . <br /> BUI4DER <br /> SIGNATURE REGIS7ERED Y/ N FEE CURRE�� Y/N '7'L1..�'��.��0� <br /> Address ��'�� M•L.l�-�93 tp c5'1`•A}Q "�'}�-� ���Q� License# C{�{... aSS3 q'-E—I <br /> ELECTRICIAN COMPANY <br /> SIGNATURE REGiSTERED Y <br /> ,��_J�•. FEE CURREh Y 1 N <br /> Address �. , l.icense# l- � <br /> PLUMBER .i--r �`'� \y j COMPANY / �j��� v L��"g��� <br /> SIGNATURE � 1� REGISTERED Y/ N FEE CURRE� Y/N <br /> Address ..G� L!/��'��i a'/�'n' �'/�� �� ticense# C���S 7 3�� <br /> MECMANtCA� CQMPANY �- � <br /> SIGNATURE REGISTERED Y 1 N FEE CURREh Y I N <br /> Address � License# �-� ' <br /> OTHER � COMPANY � � <br /> SIGNATURE REt315TERED Y/ N FEE CURREA Y/N <br /> Addresa �icense# � <br /> 1111111111111111111111111111111111111111111111111111111111111111111 <br /> RESiDENT1A� Attach(2}Plot Plans;{2)sets of Buiiding P ns;(1}set of Energy Forms;R-O-W Permit for new conslruction, <br /> Minimum ten(10}working days aftet subm� aI date. Required onsite,Constructiffn Plans,Stotmwater Plans wJ Silt Fe�ce insta8ed, <br /> Sanitary Facilities 8.1 dumpster;Site Work Permit for subdivisions/large projects <br /> COMMERCIAL Attach(3)complete sets pf Building Plans lus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new oonslruction. <br /> Mi�imum ten(1 d}working days after subm tal date. Required onsite,Const�uction Pians,Storrnwater Pians w1 Silt Fertce installed, <br /> Sanitary Faciiities&1 dumpster Site Wo Permif for aU new projects.AIi cammerciai requirements must meef comptiance <br /> SIGN PERMIT Attach(2)sets of Engineered Plans. <br /> ""PROPERTY SURVEY required for all EW construction. <br /> Directions: <br /> , Fill out application completely <br /> Owner 8�ConVactor sign back of application,notarized <br /> tf over$2500,a Notice of Cvmmencement is required (RtC upgrades over$7540} <br /> •" Agent(far the contractor)or Power of Attomey(for the o ner)would be someane with notarized Ietter from owner authorizing same <br /> OVER THE COUNTER PERMITTING (Front of Appiicati n QNy) <br /> Reroofs if shingles Sewers Setvice Upgrades AlC Fences(PlotiSutveylFootage} <br /> Driveways-Not over Counter if on public roadways..need f20W <br />