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<br />APPLICATI05 FOR PERKIT <br />CI'lY OF ZIlPIIYRIIILLS <br />B1lJIIJ)DiG DEP.ARnIE'.5T <br /> <br />~ :.Bli -~ I~() ~ <br />(f/-4J7-<;:v <br /> <br />OWNER'S NAttE \~ Q) \.:::J ~ &\ ~ .~_ 'i 'L t; ~ ~ '" i:... ~___ <br />OWNER'S ADDRESS 3 ~ 0) ~ C':t \-J ,,~ \ ~ 'C.. Dr: <br />.JOB ADDIlESS to .Lj/~ Glwnr Wh . <br /> <br />LEGAL DESCRIP'l'ION: wr(S) "% BLOCK <br />PARCEL LD.' 0.3 -a La d.. \ <br /> <br />'1 e.j .-.) -.... l ? /? <2 <br />PHONE ~ 6 ..:.:J~ <br />C E:.. ~ \\ y }-_ "-\ '\ \.\_2> <br /> <br />SUBDIVISI05 '5 \ "- \) t "\::....- ~ ~" ~,2> <br /> <br />Q)G\~ <br /> <br />o~~0b <br /> <br />~~~~\ <br /> <br />WORK PROPOSED:~5ev Construction _Addition _Alteration _Repair _Install <br /> <br />_Sign <br /> <br />_Move <br /> <br />_Deaolish <br /> <br />PROPOSED USE: X Single Faaily <br /> <br />_KIF <br /> <br />_' of Units <br /> <br />_K/H <br /> <br />_~rcial <br /> <br />_Indust. <br /> <br />_Swt.. Pool <br /> <br />Other <br /> <br />_Rest:aurant. 5: B~t::h. ~t Approval <br />k.\ \J (:>, ~\ ~< t.~\:.'~~. t <br />BUILDING SIZE: 5'-\ i>b J \~,,~) 4s~~) -:S', ~) Square Feet, Z Height <br /> <br />RESIDENTIAL: ATTACH (2) PLOI' PI.AlJS &: (2) SEI'S OF BUIIJlIBG PLA.5S 5: (1) SET ENERGY PORKS. ** <br />cottKERC'IAL: ATTACH (3) SEI'S OF BUII.DDiG PLMS 5: (1) SKI' E5ERGY FORKS.** <br />**COPT OF COIiTRACT RIlQIDIRED. <br /> <br />Y BUILDING <br />-LELECTRICAL <br />.lJmawrrCAL <br /> <br />PERI!IITS BEOUESTED <br />$ 1..0(::>") ~~~ - ~ ~ Valuation of Tot:a1 Construction <br />\ S G .AIfP Service ><...... Florida Power Corp. <br /> <br />._W.R.E.C. <br /> <br />$ :s ~ S;~ .O:J <br />. <br /> <br />Va1.uation of Kechanical Installation <br /> <br />....:::L..PLUKBIMG GAS ROOFIIIiG <br />TYPE OF CONSTRUCTIOIi: 'y... Block _~ _Steel <br /> <br />SPECIALTY <br /> <br />Other <br /> <br />YES <br /> <br />~ <br />NO <br /> <br />FllIISBED FLOOR ELEVATIOllS:__FT. <br /> <br />IS PRO.JECT IK FLOOD ZONE AREA? <br /> <br />****************************************** <br /> <br />aJIIO'RACIOR ~ECTION <br /> <br />b ~'\~0r.:)1~ <br />BIJTT.DKR (F, ,c.:..... . Cv - CO!IPMY <br />_ ~~~ S~1:e ~_ or ~gisr_ _'#(',~ ,. ."'\~" ~~ <br />S1gnat:.ure C11:y L1cense Reglstrat101l , </ 9' <br />*** ************************************** <br /> <br />ELECTRICIAH ~- t 1;::. CDIIPMIY - E E.. f::; \.." E. t:'~\ <br />\' bl .:c. State Cert. or Regist:. I <br />Simlatur~ 1 ) J...J... lJur , ".~ City License Registration I <br />v - . - ******************........********************* <br /> <br /> <br />PLUttBER C~ '\~ 'l.E \-J~~:<:, CO!IPANY<2... \\ ~ ~'J~~- ~ ~, L ~ G- <br />~ l')::kB St:ate Cert:. or Regist:. I <br />Signa {v , _ City License Registrati~~ <br />***~*******~*************************** <br /> <br />ftWIANIQL ~ <br />Signa~Jt1~' ~ <br /> <br />W!lPANYj:) ~ D \U \...) ~ '> \- \ '0 .~~ <br />State Cert _ or Regist. I <br />City License Regist:rat:ion I /01'/ <br />**********************~******************* <br /> <br />y <br /> <br />W!lPAiMY <br />State Cert:. or Regist:. I <br />City License Registration . <br />****************************************** <br /> <br />. <br /> <br />0TIfF.R <br /> <br />Signature <br /> <br />APPLICATIOB APPROVED BY <br /> <br />PERKIT OFFICER. <br />