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<br />APPLICATIOOO FOR l"ElUfIT <br />GI'IY OF ZEl"IIYRIIILLS <br />nUJILDlliIG DEPAR'IHEM <br /> <br />OWNER'S MAKE ,gRiJcL A. S ELLA-Ps <br />OWNER'S ADDRESS 'SQ2-f/ f'~K ],e.' <br />.JOB ADDRESS S'A-ML <br /> <br />PIlO!N1E <br /> <br />~(!J /~3-?{)?! <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />to <br /> <br />Il~SunDIVISIO!N1 ZHJft<ll .fff(< If[S p.. (q 122~ <br />It-U 2-( <br /> <br />PARCEL 1. D. # <br /> <br />WRK PROPOSED:_lSlew Construction .L)wdition _Alteration _Repair _Install <br /> <br />_Sign <br /> <br />_Move <br /> <br />_DellOlish <br /> <br />PROPOSED USE: ~ingle Faaily <br /> <br />_KIF <br /> <br />_, of Units <br /> <br />_HIlI <br /> <br />_Coaaercial <br /> <br />_Indust. <br /> <br />_Swi.. Pool <br /> <br />Other <br /> <br />BUILDING SIZE: <br /> <br />_Restaurant & Rea lth Depa.rn.ent Approval <br />I I <br />!b X l~ <br /> <br />,. <br /> <br />Square Feet. <br /> <br />? <br /> <br />lIeight: <br /> <br />RESIDENTIAL: <br />. COKKERCIAL : <br /> <br />AITACII (2) PLOT Pl..M'. & (2) SEI'S OF BUll.DING PLANS & (1) SET Th"ERGY FORMS. H <br />ATrACII (3) SETS OF IWII.DlliIG PLMiS & (1) SET ENERGY FORMS.-H' <br />**COPI' OF CO!N1TRACT R 8'.QUfIlUID. <br /> <br />PER"-I'TS REOlW_<;TED <br /> <br />~UILDING . <br /> <br />/~CTRICAL <br /> <br />$ <br /> <br />1,5 ()D 00 <br /> <br />Valuation of Total Construction <br /> <br />AMP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />_KECllAHICAL <br /> <br />s <br /> <br />Valuation of Mechanical Installation <br /> <br />~UHBING <br /> <br />GAS <br /> <br />ROOFING <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION: _Block <br /> <br />~mIC _Steel <br /> <br />Other <br /> <br />YIRISBED FLOOR ELEVATIONS: <br /> <br />Fl. <br /> <br />IS PROJECT IN FLOOD ZONE ARF_"-? <br /> <br />~ <br />YES NO <br /> <br />********~~******************************** <br /> <br />romRACTOR SECTION <br /> <br />COlfPMIIY <br />State Cert. or Regist. ~ <br />City License Registration # <br />********~~******************************** <br /> <br />BUIlDER <br /> <br />Signature <br /> <br />Sienature <br /> <br />CO!fPANY <br />State Cert. or RegisL =iF <br />City License Registration I <br />***"'****-f._ **"'*"'*....**.******"''''**'''''''''***-!!:*ih~*** <br /> <br />ELECTRICIAN <br /> <br />CXJMPANY <br />State Cert:. or Regist:. j# <br />City License Registration f <br />"''''******~- ***....*************"'*************"**" <br /> <br />PUJKBER <br /> <br />. Signature <br /> <br />COlfPANY <br />St:aLt Ccrt. or Regist:. #= <br />City License Registration ~ <br />*****....**~*....******"'********~***....**"*"*"*-!!:**"*** <br /> <br />MECHANICAL <br /> <br />Signa t:ure <br /> <br />. <br /> <br />COlfPANY <br />State Cert. or Regist. j# <br />City License Registration j# <br />****"'*"........~*"'*"'**"'****....******"**"***....*"********" <br /> <br />OTHER <br /> <br />. <br /> <br />Signature <br /> <br />APPLICATION APPROVED BY <br /> <br />PERHlT OFFICER. <br />