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<br />APPLICATIOIl FOR PERKIT <br />CITY OF ZEPllYKliILLS <br />B1JJTI.DIliG DEJ"AR'i1llElNlT <br /> <br />OWNER'S BAKE <br /> <br />l'\\R\ \~~ <br />SS~Q dJ) \-\) <br />~~~~ \~ ~\'\ -S~'\e(:l'\ <br />LEGAL DESCRIPTION: LOT(S) \ c:\0.lr\ A. <br /> <br />OWNER'S ADDRESS <br /> <br />\\ ~ \,\ ~od <br />8neF~ <br />1 D~"I.\'\h\\:' <br />BLOCK l~ <br /> <br />P1Imm <br /> <br />'\ '& 'd.. 4SC\~ <br /> <br />JOB ADDRESS <br /> <br />SUBDIVISION ?\n\-- ~C:()~ \ ~0.0.? <br /> <br />csL <br /> <br />PARCEL I. D.I <br /> <br /> <br />City of Zephyrhills Receipt N~ 70849 <br /> <br /> <br />5335 Eighth Street. Zephyrhills, Florida 33540 <br />(813) 788-2313 Date 1/-11) 19 9~ <br /> <br />Lots <br /> <br />Block <br /> <br />Footage <br /> <br />Rate <br /> <br />Amount Due .,jO.ol> <br /> <br />RfUnll IF ~/1~ 13 <br /> <br />(_) Paving Assessment <br /> <br />(_) Other <br /> <br /> <br />Name <br />Street No. <br />City, State, Zip <br /> <br />tn, () I~ fLll>t4 <br /> <br />F{;NU <br /> <br /> <br />NOTICE: All assessments are due and payable within (30) thirty days after <Mlllf#lLWi#l-10-9"1IOO5 <br />bear interest at the rate of 9% per annum thereafter, Please send postage for rMWr'n. 't\!'~M)1t. '" <br /> <br />$20.00:1 <br /> <br />~ <br /> <br />_PLUMBING <br /> <br />GAS <br /> <br />ROOFDiG <br /> <br />x <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION: _Block _Fraae _Steel <br /> <br />Other <br /> <br />FInSHED FLOOR ELEVATIONS: <br /> <br />Fl' . <br /> <br />IS PROJEC1' Dl FLOOD ZOIlE AREA? <br /> <br />YES NO <br /> <br />..*...........**...*....~......*...*...*.........*.................*...** <br /> <br />mHRACIOR SECTION <br /> <br />COKPANY <br />State Cert. or Regist. , <br />City License Registration t <br />.*..**....**......***.........*................*....*................... <br /> <br />BUILDER <br /> <br />Signature <br /> <br />ELECTRICIAN <br /> <br />CO!IP.DY <br />State Cert:. or Regist:. l# <br />City License Registration I <br />..***...**..***...*.*...~****..........*......**...**....*...** <br /> <br />Si!m3ture <br /> <br />Signature <br /> <br />CO!IPANY <br />State Cert:. or Regist:. , <br />City License Registration I <br />*****...***..***.******......**...*.....................................*... <br /> <br />PIJ:JKBER <br /> <br />KEClfAIIIICAL <br /> <br />Signature <br /> <br />COlIPMY <br />Stat:e Cert:. or Regist. f <br />City License Registration I <br />***...*******~*~*.*...**~...**......*...***............**......... <br /> <br />0I1IER. <br /> <br />. CO!IPANY '\'\\0 ,\\tJ\\~ \~~(J/ ~(') \ ~C~ <br />r\ \ _\ \ (\(\ State Cert. or Regist. 4# <br />" :t'f\51>J2 U\ '~a.~~~ City License Registration , \1.\<1, <br />*..*~.*...*..**..**..******...********.......*** <br /> <br />Signature <br /> <br />APPLICATION APPROVED BY <br /> <br />PERKIT OFFICER. <br />