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<br />APPLICATION FOR PER1'lIT <br />CITY OF ZEPHYRHILLS <br />BUILDING DEPARTMENT <br /> <br />OWNER <br /> <br />G q.-.y <br /> <br />fD '(I <br /> <br />D ".. ...,.. /VI". (. <br /> <br />/<00 /'v15 : <br /> <br />r ',,~ c... <br />Rei Do.le. <br /> <br />t.1-., 1= L <br /> <br />PHONE <br /> <br />S"g~ - '58 S-,/ <br /> <br />APPLICANT <br /> <br />ADDRESS <br /> <br />,.... <br />.1 Q.SSO, <br /> <br />VlAI"'Q. <br /> <br />5 ~O:3 ~ <br /> <br /><'</o~'1 <br />/1/ OJ' f-I.-. <br />. <br /> <br />C;oV'\ <br /> <br />JOB LOCATION <br /> <br />Jlue- <br /> <br />LOT SIZE <br /> <br />x <br /> <br />AREA SQ. FT. <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />PARCEL I. D .lj <br />WORK PROPOSED:____New Construction ____Addition ____Alteration ~~pair <br /> <br />____Install <br /> <br />_Sign/Temp. <br /> <br />_Sign <br /> <br />_~Iove <br /> <br />_Demolish <br /> <br />PROPOSED USE: ~Single Family <br /> <br />",:,-M/F <br /> <br />____ij of Uni ts <br /> <br />, .____M / H <br /> <br />_Commercial <br /> <br />_Indust. <br /> <br />_Swim., Poo 1 <br /> <br />Other <br /> <br />____Restaurant & Health Department Approval <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />Square Feet, <br /> <br />Height <br /> <br />RESIDENTIAL: <br />COM1'1ERCIAL : <br /> <br />ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.** <br />ATTACH (3) SETS OF BUILDING PLANS & 0) SET ENERGY FORHS.** <br />**COPY OF CONTRACT REQUIRED. <br /> <br />PERMITS REQUESTED <br /> <br />~UILDING <br /> <br />$ <br /> <br />/D '~ 30.2!- <br /> <br />Valuation of Total Construction <br /> <br />____ELECTRICAL <br /> <br />AMP Service <br /> <br />Florida Power Corp. <br /> <br />_\-l.R.E.C. <br /> <br />_MECHANICAL <br /> <br />$ <br /> <br />Valuation of Mechanical Installation <br /> <br />.- <br /> <br />____PLUMBING <br /> <br />GAS <br /> <br />ROOFING <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION: _Block <br /> <br />____Frame ____Steel <br /> <br />Other <br /> <br />FINISHED FLOOR ELEVATIONS: FT. <br /> <br />*********~******************************** <br /> <br />Signature <br /> <br />G // I .- CONTRACTOR SECTION <br />Y-.5 l.le:.o_r'lA!j' / VI Co Company <br />A4 -'- /?,-rI ; State Cert. or Rer,is t, il <br />/Y/~L;." C- V IL'I~ City License ReGL; Lra t" ion iI <br />****************************************** <br /> <br />BUILDER <br /> <br />r;-y- <br /> <br />Si!!nature <br /> <br />Company <br />State Cert. or Regist. 0 <br />City License ReGistration iI <br />****************************************** <br /> <br />ELECTRICIAN <br /> <br />Company <br />State Cert. or Regist. iI <br />City License Registration iI <br />****************************************** <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Company <br />State Cert. or Regist. 0 <br />City License Registration 0 <br />****************************************** <br /> <br />MECHANICAL <br /> <br />Signature <br /> <br />/r-' <br />* *.(* * <br /> <br /> <br />OTHF:R <br /> <br />Signature. <br /> <br />,Jj. . <br />~,r <br /> <br />" " <br />,APPLiCATION' APPR~VE~ ~y <br /> <br />PER1'IIT OFFICER. <br />