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<br />APPLICATION FOR PERNIT <br />CITY OF ZEPHYRHILLS <br />BUILDING DEPARTMENT <br /> <br />APPLICANT <br /> <br />Gordon Ten Brink <br /> <br />ADDRESS <br /> <br />35512 Chester Dr. <br /> <br />Zephvrhills, Fl. <br /> <br />PHONE <br /> <br />782-9138 <br /> <br />OWNER <br /> <br />Skydive City Inc. <br /> <br />JOB LOCATION Sl;R:ydi ve Ci ty Jump Si te <br /> <br />LOT SIZE.1.Q..(LX 800 AREA SQ. FT. ~ ?nooo <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />PARCEL 1. D .1F <br /> <br />See 18 , Two. 26 S. <br /> <br />Rng- ?? F <br /> <br />WORK PROPOSED:____New Construction XX Addition ____Alteration ____Repair ____Install <br /> ____Sign/Temp. _Sign - i'love ____Demolish <br />PROPOSED USE: _Single Family _M/F _# of Units ._i'l/H <br /> KX-Commercial _Indust. ____Swim. Pool Cold Food SeOther <br /> <br />____Restaurant & Health Department Approval <br /> <br />BUILDING SIZE: 12 X--1.L , 192 Square Fee t, 8' 2 3/4" Height <br />RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FOR..'1S , ** <br />COMMERCIAL : ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORl'lS. 'H <br /> *~'COPY OF CONTRACT REQUIRED. <br /> <br />PERMITS REOUESTED <br /> <br />~BUILDING <br /> <br />$ <br /> <br />5,750.00 <br /> <br />Valuation of Total Construction <br /> <br />~ELECTRICAL <br />NONBECHANICAL <br /> <br />AMP Service <br /> <br />Florida Power Corp, <br /> <br />_H.R.E,C. <br /> <br />$ <br /> <br />Valuation of Mechanical Installation <br /> <br />-X-PLUMBING <br /> <br />GAS <br /> <br />ROOFING <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION: ____Block <br /> <br />-K--Frame ____Steel <br /> <br />Other <br /> <br />FINISHED FLOOR ELEVATIONS: FT. <br /> <br />****************************************** <br /> <br />CONTRACTOR SECTION <br />BUILDER Gordon Ten Brink Company <br /> <br />f'" / ,] ., ,.. / State Cert. or Regist. !i <br />Signa ture . .~'Cfi..c1..ct{ 6.8_ /( L--l Ci ty License Regis tra t ion <br />****************************************** <br /> <br />C.G.C.043422 <br />i! 110 <br /> <br />ELECTRICIAN <br />.~, <br />( ;. <br />, . <br />Si!!nature 1... J l/\.....^A....'" <br /> <br />Company V -P.4.r~~'" ~2-Vlt.:?l p(,~(( ];;/'- <br />~ State Cert. or !{egist. :,f <br /> <br />_~*******~~;~*~~~:~::,~~:~~~;,~~;~~~~ ;,! ~ VI <br /> <br />""1-- <br /> <br /> <br />Company Challen <br />State Cert. or Regist. # <br />City License Registration <br />****************************************** <br /> <br /> <br />Signature <br /> <br />MECHANICAL <br /> <br />NA <br /> <br />Company <br />State Cert. or Regist, r <br />City License Regis tration ,! <br /> <br />Signature <br /> <br />**********************************~******* <br /> <br />Company <br />State Cert. or Regist. # <br />City License Registration <br /> <br />OTHER <br /> <br />Signature <br /> <br />APPLICATION APPROVED BY <br /> <br />-2i...... ...... * * * *... *~* zr;'" * * * * J_ J_ * .'- ", J. J. J, J. ,'. J. J, .'. J_ ,'. ,'. .'. J. .'. ,', <br /> <br />d 4'-''-'' d- ffy.> , >, > <br /> <br />PER~llT OFFICER. <br />