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<br />APPLI~ni]R Ftm. -"-S'FNIT <br />GI'IY OF ZIlPIIYRlUUS <br />BmIJ)DiG DEPAR'IHElNlT <br /> <br />OWNER I S RAttE <br /> <br />Ro(\ e,{tY'L- <br />~ (S" ,S-.3 3 C ~VY1 d €-,J <br />5~e~ <br /> <br />4v~" <br /> <br />mon ,$~'~ <br />Z-L~Al (' hI lls-( Fl. j3'5:tj 0 <br /> <br />OWNER I S ADDRESS <br /> <br />JOB ADDRESS <br /> <br />LEGAL DESCRIPl'IOl!i: LOI'(S) <br /> <br />B.I..OCK <br /> <br />SlIlBDIVISIOR <br /> <br />~~CELi~~'~:.--~ .3 S- -- r1 S- - ;2 I 0 OS-A - 600 (1 0- I I (', 0 <br />WORK PROPO~ED: l/.ew COOStructi.....n ~tion ___Alteration _Repair _Install <br /> <br />_Sign <br /> <br />_!!love <br /> <br />_Deaolish <br /> <br />_~rcial <br /> <br />_Indust. <br /> <br />_Swill. Pool <br /> <br />_K/H <br />fA) -+ L L- Other <br /> <br />PROPOSED USE: S:ingl.e Faaily <br /> <br />_KIF <br /> <br />_, of Units <br /> <br />BUILDIHG SIZE: <br /> <br />_Restaurant & Hea1th lIepar~t: Approval <br />X 101 L, ~ . Fr. (,.jCt If Square Feet. <br /> <br />Height <br /> <br />. RESIDENTIAL: <br />COHKERCIAL : <br /> <br />A'lTACB (2) PLOT PLMiS & (2) SEI'S OF BUILDING PI.AliS & (1) SET EliERGY FORKS. ** <br />ATTACH (3) SETS OF BUIUrDiG l'I.J'lMS &: (1) SET ENERGY FORMS. ** <br />**copy OF COIITRACT KEQ1lJIRED. <br /> <br />~TS REOUESTED <br /> <br />~UILDIHG <br /> <br />$ ,~ l ~ ~ . 0 0 <br /> <br />Valuation of Total Construction <br /> <br />_ELECTRICAL <br /> <br />Atw Servi.;~ <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />_KEGllAJlICAL <br /> <br />$ <br /> <br />Valuation 01: l!Iecbanical Installation <br /> <br />j<Ai;:,~, <br /> <br />_PLUKBIHG <br /> <br />GAS <br />V:loclt <br /> <br />KOOFTLIiG <br /> <br />SPECIALTY <br /> <br />TYPE OF COHSTRUCTION: <br /> <br />_~ _Steel <br /> <br />Other <br /> <br />FINISHED FLOOR ELEVATIOl!iS: <br /> <br />FI' . <br /> <br />IS PROJECT IN FLOOD ZONE AREA? <br /> <br />YES NO <br /> <br />****************************************** <br /> <br />cmJrI'RACIOR ~f.CTION <br /> <br />RmTllER COIfPAn ,epttYK:.m~~()I\,I~ C:h~T. ~/)( I <br />~ ~. {j fV\ 12 ". A-_ State Ce:iC't. or Regist." C () S; 77 L <br />Signature . A ~ / f l . -L.J~ City Lic~e Registration , <br />\ *********,,1,-.1<******-"***-"*-"**-"******-"******** <br /> <br />ELECTRICIAN CO!IPANY <br />State Cert. or Regist. j <br />Si2n3ture City License Registration t <br />************;:**...*...**********...***-.,**-.,**-.,*** <br /> <br />PLOKBER CO!IPMY <br />State Cert. or Regist. , <br />Signature C~ty License Registration f <br />*****"'*****~**"'*~k***************-"******** <br /> <br />KEaIANICAL COIIPANY <br />State Cert:. or Regist. 1= <br />Signature City Lic~~e Registration I <br />****************************************** <br /> <br />OTHF.R CO!IPANY <br />State CerL or Regist. , <br />Signature City Licease Regbtration I <br />.........****-.,*********************** <br /> <br />APPLICATION APPROVED BY PERKIT OFFICER. <br /> <br /> <br />,~7 <br />