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<br />APPLICATIOII FOR Pill<NIT <br />CI'IY all' ZEPllYRllILI..;3 <br />BUllDTIiG DEPA.R'IItEm" <br /> <br />OWNER I S RAHE <br /> <br />(j (<-e j <br />1 3>?:' f) <br /> <br />L '<- ~ ---r1 <br />-.J <br />f} QJ r (4.- <br />J..(Jr <br />. <br /> <br />PIIONE <br /> <br />JOB ADDRESS <br /> <br />Si9~""'" <br /> <br />a 04- t;;- <br />/63 <br /> <br />OWNER' S ADDRESS <br /> <br />" <br /> <br />LEGAL DESCRIPTION: UJI'(S) <br /> <br />BLOCK <br /> <br />SUBDIVISIOII fJ ,Lf/,f) h k1 \ / I (/ H- ~-f <br /> <br />PARCEL I. D . t <br /> <br />h'URK PROPOSED:_l"ev Construction _Addition _Alteration _Repair _Install <br /> <br />_Sign <br /> <br />__Move <br /> <br />_DeaoHsh <br /> <br />Single Faai1y <br /> <br />_KIF <br /> <br />_KID <br /> <br />PROPOSED USE: <br /> <br />_, of Units <br />-A.Swia. Pool <br />_Restaurant & Hea1th Depa.rt:aent Approva1 <br /> <br />_Indust. <br /> <br />Other <br /> <br />_~rcia1 <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />Square Feet, <br /> <br />Height <br /> <br />RESIDENTIAL : <br />COftKERCIAL : <br /> <br />ATTACH (2) PLOI' PI.AIiS & (2) SEI'S OIP' BUILDING PLUlS & (1) SET ENERGY FORKS. ** <br />ATTACH (3) SETS OF BUllDDilG PI.AIiS .& (1) SET EllERGY FORKS. ** <br />**COPT OF COnITRAGT RIlQlDJlUlD. <br /> <br />PERKITS REQUESTED <br /> <br />_BUILDING <br /> <br />$ <br /> <br />X'),DCJ <br /> <br />Va1uation of Tota1 Construction <br /> <br />_ELECTRICAL <br /> <br />.MIP Service <br /> <br />Florjda Power Corp. <br /> <br />W.R.E.C. <br /> <br />_tlECBAlUCAL <br /> <br />$ <br /> <br />Va1uation of Kecbanica1 Installation <br /> <br />_PLUMBING _GAS ROOFl.liG <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTIOII: _B1ock _Fraae __Steel <br /> <br />Other <br /> <br />FllIISHED FLOOR ELEVATIOfiS: <br /> <br />FT. <br /> <br />IS PROJECT IN FLOOD ZOBE AREA? <br /> <br />YES NO <br /> <br />****************************************** <br /> <br />BUILDER. <br /> <br /> <br />COIiD'RACIOR SECTION <br /> <br />OOltPANY ).j6VV--{.' \ ~ P 06 ~ ~ <br />State; Ce:tt:. or Regist. f C/)c_ OtA S r:;;'P- <br />City License Registration f ,;) 0 <br />**********************-******************* <br /> <br />OO!IPANY De VI V\ ,. ~ -r;:z nn dd <br />'/~ State Cert:. or Regist:. , <br />~ City License Registration I I:, ry <br />***-***************************** <br /> <br />"' <br /> <br />Signature <br /> <br />ELECTRICI.AB <br />Silnl::llture 'O~ <br /> <br />PJ.OftBER <br /> <br />Signature <br /> <br /> <br />OO!IPARY <br />Statp ("..e~t: _ or Reg-i ~t:. _ :I <br />City License Registration I <br />****************************************** <br /> <br />=.:n~:1~~ <br /> <br />City LicedSe Registration t ,~ <br />******************~*~************** <br /> <br />Signature <br /> <br />KECllAliICAL <br /> <br />0T1IF.R <br /> <br />Signature <br /> <br />OOltPPlJfi <br />State Cert. or Regist. f <br />City License Registration f <br />************* ".'3:******;0*********"''''**''''''*'''*** <br /> <br />APPLICATION APPROVED BY <br /> <br />/1<< M~ ~ -V\..f))., , <br /> <br />PERKIT OFFICER. <br />