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<br />APPI,;]rG..!\TIOJlilI FOR PER."iTT <br />crl'Y OF ZEPHYRlITLLS <br />llU1TILDIJIilIG DlE;PARJrKE'NT <br /> <br />OWER'S NAME !J1 tf y III f[ s' JJl//{ e I( fi /';no JVd / <br />OWNER'S ADDRESS ~ /S / J, e NlVef <br />, , <br /> <br />5;:IJMt: <br /> <br />mOl!\'E ?X1-:-- --- :5 ( cf ,2 <br /> <br />JOB ADDRESS <br /> <br />LEGAL DESCRIPTION: LOY(S) <br /> <br />B.LOCK <br /> <br />SUBDIVISION <br /> <br />f)&jL J~ <br /> <br />PARCEL 1. D . #. <br /> <br />k~RK PROPOSED:____Xe~ Construct~on ~Addition ____Alteration ____Repair ____Install <br /> <br />____Sign <br /> <br />____nove <br /> <br />____Demolish <br /> <br />PROPOSED USE: <br /> <br />Single FallIlily <br /> <br />____KIF <br /> <br />_* of Units <br /> <br />_H/H <br /> <br />____ \.ommlercial <br /> <br />_fudUlSt. <br /> <br />_Swim. Pool <br /> <br />Other <br /> <br />____Res1t;:mrant 0& ! ',,",alth Departlll€'lllt Approval <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />Square Fee t. <br /> <br />Height <br /> <br />RESIDENTIAL: <br />COKrliERCIAL : <br /> <br />A1TACII (2) PLOT Pf ,;UIIS 0& (2) SEI'S OF BillLDING PLANS 0& 0) SET ENERGY FORMS. ** <br />ATTACH (3) SEIS G: RUUDlllG PI..MJJS 0& (1) SET ENERGY FOfu"lS. ~~' <br />-!.--!.-COP1!" OF ro~"TR."'C RIE:QID:mID. <br /> <br />PEltllfi.TS REQUESTED <br /> <br />ABUILDING <br />_ELECTRICAL <br /> <br />$ d @-OO <br /> <br />Valuation of Total Construction <br /> <br />AMP Service <br /> <br />Florida P<>>~er Corp. <br /> <br />W.R.E.C. <br /> <br />_HECHMIi"ICAL <br /> <br />$ <br /> <br />ValWl',ltion of Mechanical Installation <br /> <br />____PLUMBING <br /> <br />GAS <br /> <br />ROOFDI'G <br /> <br />SPECIALTY <br /> <br />TYPE OF coNsTRucnm1i: ____Bloc! <br /> <br />_Fr3lllle _Steel <br /> <br />Other <br /> <br />FIlnSHED FLOOR ELEVATIONS: <br /> <br />,!PT. <br /> <br />IS PROJECT IN FLOOD ZONE: AREA? <br /> <br />YES NO <br /> <br />x~~~~~ ~~~*~~~~~~~~~~~*~~~~~~****~:~~~~*~~ <br /> <br />OI)1NJ'][Rf\c:roR SECT'IOiN <br /> <br />BUILDER <br /> <br />OOOfPMW 4? I (/{ (:" G~ (( 1(; /? //1 S C,-";) M ?,,-c'u 1'6J'l. <br />(~~ ",,011 /) '" d.7 4 0 S~ate ~ert. or R~gist. _ #! <br />//2/ "..-r4cc Ct!.-/ d....f:~-...<J C1ty L1cense Regl.stxatwn #I <br />~~~~~~ ,~~~~~~~~~*~:~~~~~~~~~~*~~~~~~:~~~~* <br /> <br />Signature <br /> <br />ELECTRICIAN OGMPANY <br />State Cert. or Regist. #I <br />Si~tllre City I.icense RegistratIon :I <br />~'i:~"f;~-::;' ':t::,!::{i:1i;:'fl:1l:11:'!!i:'f/:-!1:,!:~':f;~'ik'R:~11',!:.g;'f::'ir'f:'*'!:''f::it:*-e:'~~~-i:x~ <br /> <br />Signature <br /> <br />COI!fPANY <br />State Cert:. or RegisL #f. <br />City !.i'C:~e RegistTation !IF <br />~*~~~~ ~~~~~~~~.~~~~~~~~~~~~~*~~*~~~~~~**~~ <br /> <br />PLlJlKBER <br /> <br />Signature <br /> <br />OI:mPANY <br />State Cert. or Regist. #I <br />City License Registration ~ <br />~-!.-~~~;~-!.-~~~~-!.-~-!.--!.-~~-!.-~-!.-~-!.--!.--!.-*~~-!.--!.--!.-~-!.-~~~~~~~~ <br /> <br />MECHAlnCAL <br /> <br />0'TlJE'R OOHPAID? <br />State Cert. or Regist. #I <br />Signature City License Registration #I <br />~~*~t~~~*~*~*~~~~~~t*~~~~~*~~~*~~~*~~~~~~~ <br /> <br />APPLICATION APPROVED BY <br /> <br />PERi/HT OFFICER, <br />