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<br />APPLit..A'i':'-'u~ FOR "pEmaT <br />'-'TIT OF ZEPIIYRIlTLLS <br />BUILDIJiG DEPAR'DIt!'NT <br /> <br />OWNER'S RAKE <br /> <br />~'~',..~,? C, c: <L-.f- '- <br />OWNER'S ADDRESS 6;;5'(j l( /!-(..n-/t IJ.:.3/rs-:- <br />JOB ADDRESS /..-01" ,0 A t...J 41'-1:f u.:s/(;c. ~ '~t <.1 ~ I/~ /-r' t .IH) ~ <br />LEGAL DESCRIPTImJ: I.OI'(s) ! 6;,.- _aLOCK SUBDIVISIOIIi S";'j\.(Y'( <br /> <br />Il ~/v,-< <br /> <br />PHONE <br /> <br />r; t,:) (f S <br /> <br />.PARCEL LD.' c) '3 <br /> <br />,.;l, (~ <br /> <br />J.. l <br /> <br />01)... 0 <br /> <br />CJ 00 c"x') <br /> <br />/ oi/J-c: <br /> <br />WRK PROPOSED:_lliev Construction _Addition _Alteration _Repair _Install <br /> <br />_Sign <br /> <br />_l!tove <br /> <br />_DeIIolish <br /> <br />PROPOSED USE: <br /> <br />Single Faaily <br /> <br />_KIF <br /> <br />_, of l.IInits <br /> <br />_H/H <br /> <br />_~rcia1 <br /> <br />___Indust:. <br /> <br />~SwU.. Pool <br /> <br />Ot:her <br /> <br />_Restaurant &: Bea11:h n~t Approva1 <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />Square Feet. <br /> <br />Height <br /> <br />RESIDENTIAL: <br />COHKERCIAL : <br /> <br />A'lTAGII (2) PLOI' PIARS &: (2) SEIS OF BUilDING PLANS &: (1) SEI" ENERGY FORMS. ** <br />A'lTAGII (3) SEIS OF BUII.DlliG H....UIS &: (1) SEI" mmRGY FORKS. ,U <br />*:l:COPY' OF COMrRAC'l' REQ~. <br /> <br />FfmlI'I'S REUUESTED <br /> <br />_BUILDIHG <br /> <br />.,..--- <br />$ qOGO <br /> <br />J?TduatiOlt {lIf Tot:al Construction <br /> <br />_ELECTRICAL <br /> <br />AKP Sel.-'ffj;:ce <br /> <br />.Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />_KECHANICAL <br /> <br />$ <br /> <br />~a1uatiOL, of Kecbanica1 Installation <br /> <br />_PLmtBIHG GAS BOOFIltiG <br /> <br />SPECIALTY <br /> <br />TYPE OF COHSTRUGl'IOIil: _Block ___Fraae _,.,_.Steel <br /> <br />Ot:her <br /> <br />FUiISHED FLOOR ELEVATIOIilS :___FI' . <br /> <br />IS llXCJE," IN FLOOD ZONE AREA? <br /> <br />YES NO <br /> <br />:I::I::I::I::I::I::I::I:*~*:I::I:~*:I::I::I:~:I::I:*~:I:~*~:I::I::I::I::I::I::I::I::I::I::I::I::I:* <br /> <br />BmTJ)Y.R <br /> <br /> <br />CODO'RACIOR SECTION <br /> <br />COI!tPAOOY /-\ () ~ \ <..J--"-'- P~~k S <br />State Cert:. or Regis!:.' ~ (?<:-.O.}... l3 ~').---' <br />City Licen~e Registration.' <br />:1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1: <br /> <br />,....,.---. <br />~^--'-- <br /> <br />Signature <br /> <br />F.I.F.cnuCIAH <br />siPl1="tureD~ <br /> <br />j celPMY>>_IAUl;-S ----r;:? t/I~clpj +z C". <br />State Cert:. or Regist.' /Z.R ~ "l ~?8'" <br />~ City License Registration I ~ q <br />:1::1::1::1: :I::I::l:AAA~~:I:**:I::I:~:I::I::I::I::I::I::I::I::I:*:I::I::I::I::I::I::I::I::I::I::I::I: " <br /> <br />ml!IP-MY <br />State Cert:. or Regist:. 411= <br />,. ___._ City License Registration I <br />:I::I::I::I::I::I:':!t:l::I::I:'l.> ,,:,'; :1::1::1::1::1::1::1::1:\1':1::1::1::1::1::1::1::1::1::1::1::1::1::1::1::1:*:1:*:1: <br />\ <br />~AltfV~~ ~~.,,_f1.lVW\('V~Vi'Y) <br />State Cert. or Regist. , <br />City License Registration I ~ <br />:1::1::1::1::1::1::1::1::1::1::1:.:1::1:*:1::1::1::1::1::1:*:1::1::1::1::1::1:*:1::1::1: <br /> <br />PLOHBER. <br /> <br />Signature <br /> <br />tiEalARICAL <br /> <br /> <br />Signature <br /> <br />-" <br /> <br />COlIPAi'ln_ <br />State Ckrt. or Regist. I <br />City Licease Registration I <br />:I::I::I::I::I::I::I::I::I::I:****:I:~**:I::I::I::I::I:*~:I:*:I::I::I::I::I::I:*:I::I::I::I::I::I::I::I: <br /> <br />. <br /> <br />0'I'1I'F.R <br /> <br />Signature <br /> <br />APPLICATIOIi APPROVED BY <br /> <br />PERKIT OFFICER.. <br />