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<br />APl'I:iClr:mml FOR PERKIT <br />CI'IY OF ZltfuIKh n.T..~ <br />BUllDDiG DEPAKIIImiT <br /> <br />OWNER' S <br /> <br />IWIE ~ffil;~/oV pa/i6 <br />ADDRlrSS ~ !?-/9' ~// ~/~ <br />(.7 / <br />, J/?Y7/ <2- <br /> <br />PIlOSE <br /> <br />7cftf- /~ZJS <br />. <br /> <br />OWNER' S <br /> <br />JOB ADDRESS <br /> <br />LEGAL DESCRIPTIOlIiI: I.OT(S) <br /> <br />~SUBDIVISIOR <br /> <br />PARCEL I.D.f <br /> <br />WORK PROPOSED:_~ev Construction _Add.:i1:.ion __Alteration ..L..Repair _Install <br /> <br />_Sign <br /> <br />_!!love <br /> <br />_Deao1ish <br /> <br />PROPOSED USE: <br /> <br />Single Faai1y <br /> <br />_H/F <br /> <br />_, of llfnits <br /> <br />_K/H <br /> <br />_~rcia1 <br /> <br />_Indust. <br /> <br />_SwI.. Poo1 <br /> <br />Other <br /> <br />_Restaurant &: Bea1th Depart.ent Approva1 <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />Square Feet, <br /> <br />Height. <br /> <br />RESIDElfTIAL : <br />COftKERCIAL : <br /> <br />A1TAGII (2) PLOI' PI..A.NS &: (2) SEIS OF BUILDDiG PLUS &: (1) SEI' ENERGY FORKS. ** <br />ATI'ACH (3) SEIS OF BUllDIRG P1MiS &: (1) SET ENERGY FORMS. ** <br />**COPT OFCOlNTRAC.T RIlQIIJIRED. <br /> <br />_BUILDING <br /> <br />PERI!IITS REQUESTED <br />$ d ,--:r '7 S' 02- Va1uation of ~~ot:.a1 Construct.ion <br /> <br />_ELECTRICAL <br /> <br />A!IP Service <br /> <br />F10rida Power Corp. <br /> <br />W.R.E.C. <br /> <br />_MECHANICAL <br /> <br />$ <br /> <br />Va1uation of Hechanica1 Installation <br /> <br />_PLUKBIWG GAS IWOFrI!iG <br /> <br />SPECl:M.n <br /> <br />TYPE OF CONSTRUCTIOINl: _B1oclt _FraIIe ___St:.ee1 <br /> <br />Other <br /> <br />FINISHED FLOOR :EI.EVATIOINlS: <br /> <br />FI' . <br /> <br />IS P.RO.JECT IN FLOOD ZONE AREA? <br /> <br />YES NO <br /> <br />****************************************** <br /> <br />COJD'RACIOR SECTION <br /> <br /> <br />I <br />BUTTJlF.R ~ COIIPMY ';/I'm <br />/ ", ff /? ), . // /J J State Cert. or Regist. I <br />Signature ~ 'd4'.//~~;1 #~2b ;/~ City License Registration <br />****************************************** <br /> <br />ELECTRICIAN <br /> <br />COIIPMY <br />State Cert. or Regist. I <br />City License Registration t <br />****************************************~* <br /> <br />SiPnature <br /> <br />PI.lJttBER <br /> <br />Signature <br /> <br />COIIPMY <br />State Cert. or Regist. , <br />City License Registration I <br />****************************************** <br /> <br />KEalAliICAL <br /> <br />aJltPABY <br />State Cert. or Regist. # <br />City License Registration t <br />****************************************** <br /> <br />Signature <br /> <br />Signature <br /> <br />COIIPARY <br />State CerL or Regist. , <br />City License Registration , <br />****************************************** <br /> <br />. <br /> <br />0T1IF.R <br /> <br />APPLICATION APPROVll'D BY <br /> <br />71<fd J: ,,/J A'l.-, T <br /> <br />PERKIT OFFICER. <br />