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<br />.\PPLICATIOJif FOIl PERKI.T <br />ern OF :zE1I'II'fRHILL <br />BmUH.J!IG DEPA.'lt'DIEMT <br /> <br />OWNER' S RAKE <br /> <br />t. (, <br />- <br /> <br />) <br /> <br />( , / <br /> <br />I 'J. ....-:~ /....-' <br /> <br />moB <br /> <br />-, <br />, <br /> <br />1- " <br /> <br />) j~... -,' !, <br /> <br />OWNER' S ADDRESS <br /> <br />I <br /> <br />~ <br /> <br />" / <br /> <br />v' / ': <br /> <br />- / I. <br />, -'---r--' ,1~.1...- <br /> <br />/ <br />/><.. <br />/ <br /> <br />" /. ' <br /> <br />JOB ADDRESS <br /> <br />'~ :~ <br /> <br />,/ <br />I <br /> <br />I <br />! <br />t. 1'/ <br /> <br />/ ; <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />)f <br /> <br />BLOCK______SUBDIVISION <br /> <br />,I, ( <br />I <br /> <br />[\. <br />I ,'- '. " <br /> <br />PARCEL LD.# Ji <br /> <br />f.. <br /> <br />" I <br /> <br />'- <br /> <br />,... j l <br /> <br />/ I <br /> <br />WORK PROPOSED:~lrev Construction _Addition _Alteration -----Repair _Install <br /> <br />_Sign <br /> <br />_Move <br /> <br />____Deaolish <br /> <br />PROPOSED USE: <br /> <br />i~1:Dgle Faaily <br /> <br />,_KIF <br /> <br />_' of Units <br /> <br />_K/H <br /> <br />_~rcial <br /> <br />_Indost. <br /> <br />_S,"--. Pool <br /> <br />Other <br /> <br />~Kestaurant &: Health ~t Approval <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />Square Feet. <br /> <br />/,\','. <br /> <br />Height <br /> <br />RESIDENTIAL : <br />COHKERCIAL : <br /> <br />AtTACH (2) PLOt' PLANS &: (2) SEI'S OF B1ITLDDfG PI..A.5S &: (1) SET RNERGY FORKS. ** <br />A1TACH (3) SEI'S OF BmLDB!G PL.~JifS &: OJ SET ENERGY FORKS. 'H, <br />"''''COPT UF CONl"RAGI' REQm:RED. <br /> <br />PERI!tITS t:FQ!liRSTED <br /> <br />_BUILDING <br /> <br />$ <br /> <br />Valuation ._,I Total Construction <br /> <br />_ELEC'l'RICAL <br /> <br />AKP Service <br /> <br />_, .Flurida Power Corp. <br /> <br />W.K.E.C. <br /> <br />_tlECllAHICAL <br /> <br />$ <br /> <br />Val.f'I3tin, , o:f "..ecbanical Installation <br /> <br />_PLUKBING GAS <br /> <br />F~FiJiG <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION: _Block <br /> <br />_FraIIe _Steel <br /> <br />Other <br /> <br />FII!IISHED FLOOR ELEVATIONS: <br /> <br />IT . <br /> <br />IS 'PIID,"ffiGI' DI FLOOD ZONE AREA? <br /> <br />YES NO <br /> <br />.....................*""'......* ' ,"'.........!'c....v...oJ:-......i!'*.................................................... <br /> <br />cmII'I'RACIOK SEGI'ION <br /> <br />i I <br /> <br />CUfPArry ! <br />St:ate Cert. or Kegist. '+---L-, <br />Signature ; Cit.y Lioeense Registration , <br /> <br />n=rRICIAR ..........._.=:.~LvL(jL. <br /> <br />:~:~~. , St:ate Cert. or Kegist.' tt7 tf/ /::l /{/ I <br />S-=-- e " City l,icense Registration # .;{ CJ ~ <br />.........................**...................................~~....*........*....**.............................................. ' <br /> <br />~, <br /> <br />1"nIIn" "'1In<f ,', 0 /, oj, ;;, <br />~~J:.j//"'F'/\ <br />St:a. ; :':~<::..:.;,:. or Regist. , <br />City License Registration I <br /> <br />BUTTDER <br /> <br />PLOftBER <br /> <br />-.1:....7 <br /> <br />Signature <br /> <br />.....~~~~ ""',f; .~t'.t;..:.':r.t'4-~.:. '!';':" -I; 1i.'.:"~~'-= ..:,;j;'-;;; '.!:-,10~ -:. 'A '.c:-::.'~~ -:.. -S:11'J.~-A <br /> <br />Signature <br /> <br /> <br />WllPA'ilY liz AI ~ _ C .o..f/ffJ <br />St:ate Cert. or Ke - t.' # Oa ~-YI'2... <br />City l~icense Registration I 7 I <br />................~........*............................................~*...*...................~.......................... <br /> <br />KEaJAlfICAL <br /> <br />COItPLRY <br />Stat~ CeT~. or Regist. , <br />City ~;~:....,.:efiSe Registration , <br />......................~....................-il->l:....................* .<it.......................................................... <br /> <br />Ii <br /> <br />O'TIIF.R <br /> <br />Signature <br /> <br />APPLICATION' APPROVED BY <br /> <br />PERKIT OFFICER. <br />