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<br />APl"LIQ\TIOINl FOR PERMIT <br />CITY OF ZE:FIIYRIITLLS <br />llUrrll..DING DEPAR'Il1mNT <br /> <br />OWNER'S NAHE?~~~ Y <br />OWNER'S ADDRESS 5"'l ,~ G ~ L '-- <br />JOB ADDRESS~ L{ lO ~\ ~vi=:- ~ <br />LEC..AI. DESCRIPTIONI': LOY(S) a. \ IU...QCK SlJIBDI\lIISIm~S\'-\J~~ <br />PARCEL LD.' \:) '"3:,.- a \.9. -, ~ \ - D \ ~ ~ - CJ~~~~ .... a &,l 0) <br />. . <br /> <br />owEN :> <br />~'-..vj) <br /> <br />Q) '?\ '\<- S <br /> <br />PlIO~E ~ ~ ~_. () t{ 5" q <br />C ~ N \ LL S <br />tJ \~ \ V 'C.., <br /> <br />~ ~ l<._~ <br /> <br />WORK PROPOSED: ~ 1Jf.e'IN OlmstrucL on <br /> <br />_Addit.ion _Alteration ,_Repair <br /> <br />_Install <br /> <br />_Sign <br /> <br />_l!fove <br /> <br />_DeJJlOlish <br /> <br />PROPOSED USE: <br /> <br />~ingle FaDily <br /> <br />_H/F <br /> <br />_' of Unit.s <br /> <br />_H/H <br /> <br />_Commercial <br /> <br />_Indust.. <br /> <br />_Swilll. Pool <br /> <br />Other <br /> <br />_Restaurant &: ! '{'31th Depart:llle'nt. Approval <br /> <br />BUILDING SIZE: S C') X 5 b , \ l.o ~ eJ \-." \ U <br /> <br />Square Fee t, <br /> <br />q\ <br /> <br />Height <br /> <br />RESIDENTIAL: <br />COHHERCIAL : <br /> <br />ATTACH (2) PLOT Pf ,;\lNIS &: (2) SETS OF BUILDIINlG PLAOOS &: (1) SET ENERGY FORMS. H <br />ATTACH (3) SETS C:' BUUJlDilG PIAlNlS &: (1) SET ElNIERGY FORMS.-:!:-:!: <br />'iC:!:COPY OF COlNlTRAC' REQll.JJTIUlD. <br /> <br />-'-BUILDING <br />V ELECTRICAL <br />V <br />~~ <br /> <br />PElmITS REQUESTED <br /> <br />$ Sf; ~a(S) <br />\S~ <br /> <br />.$ ~S~~. ~~ <br /> <br />Valuation of Total Cons~ruct.ion <br /> <br />AMP Service ~ Florida Power Corp, <br /> <br />W.R.E.C. <br /> <br />Va1.uation of Mechanical Installation <br /> <br />GAS <br />V:lOC' <br /> <br />ROOF:rnC <br /> <br />SPECL\LTY <br /> <br />TYPE OF CONSTRUCTION: <br /> <br />_FraDl!e <br /> <br />_Steel <br /> <br />Other <br /> <br />FINISHED FLOOR ELEVATIONS: <br /> <br />..1'']'' . <br /> <br />IS PROJECT IN FLOOD ZONE AREA? <br /> <br />~ <br /> <br />YES NO <br /> <br />:!:-:!:'iC:!::!:~ ~:!::!::!::!::!::!:'iC**:!:*'iC-:!::!::!:'iC*'iC'iC:!::!:'iC'iC'iC:!::!::!:'iC-:!::!::!::!::!:'iC <br /> <br />BUILDER \ ~ <br />Signature'R'-> <2.;, , <br />*-:1' -,!;-!]:; <br /> <br />OONITRAC'fOR SEG'l'IOlNl <br /> <br />WHPMUY ~~J ~-~ ~ \"-'\ E.. t\ () l\A E. <;. <br />St:ate Cert. or Regist. #iCJ ~_ Q...O \ ~ '-) \3 ~ <br />Cit:y License Registration #: ?/9 <br />~:!:.~*'iC'iC:!::!::!::!:'iC~*:!::!:'iC:!:'iC~-:!:'iC:!:~'iC:!:~'iC~'iC:!:.~'iC* <br /> <br />ELECTRICIAN f E:E OOlHPANY F ~ ~ t <br />~ ?J. 1./ ..//7 ~ State Cert. or Regist.. if:: <br />Si~ature V l/{$..-/' ~ Cit.-y License Registl'"3tion <br />:!::!: .:!:~ ~~:!:'iC~:!:'iC:!::!::!::!::!:'iC:!::!::!:*:!::!:'iC'iC:!::!::!:'iC****'iC'iC.:!:*'iC <br /> <br /> <br />PLlJIHBER ~ V\ cmlPAlNlY~~ ~,--\...;-e.~,~e.~" \) L~~ <br />O 7/\ St:ate Cert. or RegisL '!It <br />Signature ~/ '-----" Cit:y License Registration I \ ~ );"' <br />~'iC:!:'iC~~~*'iC:!:*:!:'iC:!::!:'iC:!::!:'iC:!::!::!::!:'iC'iC'iC'iC'iC'iC:!::!::!:'iC'iC'iC*:!:-:!::!:.* <br /> <br />HEmANI~ <br />Signatur _ <br /> <br />, cmlPATNry {>~ ~Q) \.A...) ~ <br />\\ _____lJ A State Cert. or Regist. #= <br />~ ~ City License Regist.ration Kt <br />'iC*'iC:!::!:~:!::!::!:*'iC~:!::!::!::!:'iC'iC**:!:'iC'iC'iC:!:-:!:'iC'iC:!::!:'iC.:!:'iC*:!::!:'iC~. <br /> <br />C} ~.:>\)\ uS y <br />/ <br />./ () 7 ------.- <br /> <br />0T1IER. <br /> <br />ClOOIPMJJY <br />State Gert. or Regist. #I <br />City License Registration #= <br /> <br />Signature <br /> <br />*~~~*~ ~~~~~~~***~~~*~~~~~~~*~*~~~~**~~~~~ <br /> <br />APPI.IGATION APPROVPD BY 'J1 ,(~";J 4 eM;,-,,.- <br /> <br />PERKIT OFFICER. <br />