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<br />APPLICATION FOR PERKIT <br />CITY OF ZEPBYRllILLS <br />BUILDllIG DEPAR'IKENT <br /> <br />OWNER'S <br /> <br />MAKE /5:; r/{} r() - 0/- ;r(v,'fJ rrI \. 717a;e I" <br />ADDRESS (,/27 (!(J/})fO &.7f'{Jhyrhrl/s I rt- <br />(P/23 &nlf'O &JrT'{'f 7e/)/"yrA///\ ) <br />f ' <br /> <br />PHONE <br /> <br />+-;?;2- '2~ 7?-9 <br /> <br />OWNER'S <br /> <br />JOB ADDRESS <br /> <br />TL 33S'/{) <br /> <br />LEGAL DESCRIPTION: LOI'(S) <br /> <br />BLOCK <br /> <br />SllJBDIVISION <br /> <br />PARCEL I. D.I <br /> <br />WORK PROPOSED:_lNlev Construction _Addition _Alteration' _Repair ~stall <br />/lJot5/{ E f)J/Y/t:- <br /> <br />_Sign <br /> <br />_I!tove <br /> <br />_DeJI01ish <br /> <br />PROPOSED USE: <br /> <br />Single Faai1y <br /> <br />_KIF <br /> <br />_, of Units <br /> <br />~H <br /> <br />_~rcia1 <br /> <br />_Indust. <br /> <br />_Swia. Poo1 <br /> <br />Other <br /> <br />_Restaurant &: Hea1t:h Depart:Dlent Approva1 <br />BUILDIMG SIZE: 2 Lj i X i../ ()' , <br /> <br />Square Feet, <br /> <br />Height <br /> <br />RESIDENTIAL: <br />COHrtf.ERCIAL : <br /> <br />AtTACH (2) PLOI' PLWS &: (2) SEIS OF BIITLDUl!G PIJ\lNlS &: (I) SET ENERGY FORMS. u <br />ATTACH (3) SETS OF B1llIJ)DilG PLWS &: (1) SET EINIERGY FORKS. -f:':!, <br />-f:*COFY OF CONTRACT REQm:RED. <br /> <br />PmmITS REQUESTED <br /> <br />_BUILDING <br /> <br />$ <br /> <br />Va1uation of Tot:a1 Construction <br /> <br />_ELECTRICAL <br /> <br />Artf.P Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />_KEGllAlfiCAL <br /> <br />s <br /> <br />Va1uation of Hechanica.1 Insta11ation <br /> <br />_PLUMBING <br /> <br />GAS <br /> <br />ROOFING <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION!: _Block _F"r;me _Stee1 <br /> <br />Other <br /> <br />FINISHED FLOOR ELEVATIONS: <br /> <br />FT. <br /> <br />IS PROJECT IN FLOOD ZONE AREA? <br /> <br />YES NO <br /> <br />-f:****-f:********************-f:***-f:*****-f:***-f:* <br /> <br />COIlTKACIOR SECTION <br /> <br />BUILDER CQ!IPMl!Y <br /> <br />S~tureLf), I all ;, tl jJ,-c.~ ~~\~:';e O;e:~:;~~i:" , <br /> <br />*-f:*-f: *-f:**-f:*-f:-f:**********-f:**-f:**-f:************ <br /> <br />ELECTRICIAN COIIPMiY <br />..~ ~- 'f: State CerL or Regist. 4# <br />SiPl1atur~ . ~.J Cit::y License Registration' I <br />***** ************-f:-f:********************** <br /> <br />PUllKBER ~ CQ!IPMiY <br />~ 'State <:erL or RegisL 4#, <br />Signaturif'~L~ ~(1 J.-fi ,) City License Registration I <br />****** ********************************** <br /> <br />KECHAlUCAL~ ~/--: " CQ!IPMiY <br />/ State CerL or RegisL 41 <br />Signature '.<..A.A~ ..; j Cit::y License Registration I <br />**** * *******************************~*-f: <br /> <br />0'T1IF.R <br /> <br />S~~~!{ <br /> <br />f ~-~,,~ <br />z; AP~ 1ft(-H~'PPROVED <br />_ ,--..r:J(S:~- <br />~~ ",()...._ V1'- ,,,",. <(tv ,c <br />~.. :;'A".. ...vv .,- ~",,: <br />""".,,~#70 ......,.........~~. ' ,.,," <br />"'fl ~=t '=10.,. . <br />""f/IUIU"I\\!" ' <br /> <br /> <br />CQ!IPMfi <br />S~te'"'cert. or Re~t:.= f <br />61:-..:1' L1.cen::.e Registration j <br />**** ***********************~*******-f:~* <br /> <br />...-_-.c....".......___........ <br /> <br />BY <br /> <br />PERKIT OFFICER. <br />