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<br />APfllLICATIC'1i rO)L PE.'RIifiT
<br />CI'IY ~fl' ~.I.I.s
<br />BlJIIlilI5G DEPARIlIIE'Nl'l'
<br />
<br />OWNER'S RAIlE D U)~~ ~ ~ \---\ ~k, ,~ }
<br />OWNER'S ADDRESS ~ D \5 c))' , ~ : ~g.t1,ti-d 5 t..f
<br />~ 9( L-f S- QtfJ (l.. y---P. 0 R d
<br />LEGAL DESCRIPTION: WI'(S)_. .__ __ _ _BI.OCK
<br />
<br />PH05E~ '7 '::) ~ Lf.-l.3 1
<br />tv r-- s + We: c. LF-. '( C' en- f IS L
<br />Z ~ 10 h y (L h t ':'c s
<br />I I
<br />S1JIBDIVISIOM_.
<br />
<br />JOB ADDRESS
<br />
<br />PARCEL I. D. f
<br />WORK PROPOSED:_riev Construction --.-Jl.ddition v-Alteration _Repair _Install
<br />
<br />_Sign
<br />
<br />_!!love
<br />
<br />_Deaolish
<br />
<br />PROPOSED USE:
<br />
<br />Single F3IIily
<br />
<br />~/F
<br />
<br />-2.., of llJnits
<br />
<br />_K/H
<br />
<br />_~rcial
<br />
<br />_IndUst.
<br />
<br />_Swia. Pool
<br />
<br />Other
<br />
<br />_Rest:aurant &: Health Depan:.ent Approval
<br />
<br />BUILDING SIZE: ~ (J X J 4 ,
<br />
<br />I 'i ~'o
<br />
<br />Square Feet,
<br />
<br />( I
<br />4
<br />
<br />Height
<br />
<br />RESIDENTIAL :
<br />COttKERCIAL :
<br />
<br />ATTACH (2) PLOf Pi..MiS &: (2) SEIS OF B1JIILDIMG PLArmS &: (1) SET
<br />ATTACH (3) SETS OF BUTI.DlllG PI.~S &: (1) SET EOOERGY FORMS. **
<br />**COFY OF CONTRACT RIlQm:RED.
<br />
<br />PERKITS REQUESTED
<br />
<br />ENERGY FORKS. ** L/'ES>
<br />L pO:A ,,-
<br />r tde~ ~O(~l{
<br />6~ ':f-- ~ 1
<br />~/p-
<br />
<br />yI' BUILDING
<br />VELECTRICAL
<br />V HECHAlUCAL
<br />v/ PLUMBING
<br />
<br />$
<br />
<br />\ 0 \ 0 <J Q J7aloation of Tot:a1 Construction
<br />I
<br />I {) 0 AHP Service _~_Florida Power Corp.
<br />
<br />W.R.E.C.
<br />
<br />$
<br />
<br />1'1.
<br />
<br />0.0 ,
<br />
<br />... :>
<br />
<br />Valuatioc, of Kechanical Installation
<br />
<br />GAS
<br />/B10<:k
<br />
<br />___ROOFIliG
<br />
<br />SPECIALTY
<br />
<br />TYPE OF CONSTRUCTION!:
<br />
<br />_FraIIIe
<br />
<br />_Steel
<br />
<br />Other
<br />
<br />FINlISHED FLOOR ELEVATIONlS:
<br />
<br />FI' .
<br />
<br />IS PRUJECT IN FLOOD zmm AREA?
<br />
<br />YES NO
<br />
<br />*********...... ~...*...*...-Al'.,,***""*******************
<br />
<br />ornnKACIOR SECI'ION
<br />
<br />BUILDER, '4 ~ COI!tPMUY c.. rL 0 sse 0 {'" s f' Co.
<br />n "'" " J.. A 'State Cert. or Regist. f
<br />Signatu~ W ~~ ' \:' i \ ~_ City License Registration f C 'd..
<br />******v***it**it*iI:*:i:'f:************************
<br />
<br />I tV ( ,
<br />
<br />Fe '/"'/-v
<br />ELECTRICIAlI fi::.E; E.L..Ec.::r~l Co ' COIIPMiY -~, C-- ':..:::- /-~ ,/ ,,~ /i?, <:::::...
<br />J J~ . .)~ Sta'" ,,,.,ft:. or Regisr.' /'" 1! c'(',('-s<///d
<br />Silmaturd//.c;; . /1/ 't:< L- City }i.icense Registration f~ /J
<br />***.... **.......*~*4*...*******.******************
<br />
<br />PL1DtBER C.f.+~;f 1'!>A-~ ~(..'41!!>>a.. COlIPMY
<br />
<br />Signature (j(/l~/l2. ~, ~~,~e,~,~~e o~e:~;~:~~i:n
<br />
<br />*********",,,,**"~iI::irof::--I/J:,""'*' ,',*, '*'f1i:***************
<br />
<br />/ FOCJYlcS-Slf)
<br /># ,'iLJt6'
<br />
<br />KEGlJAlfiCAL
<br />
<br />r
<br />~; 0 /l/#l{ <;
<br />
<br />Signature
<br />
<br />~rJr-J -(,'50
<br />
<br />~~
<br />h^-' .
<br />~ --~, .--"
<br />**.:::':I'",:Ao ~~_.;'. lo\.-.;.. J:'i::~
<br />
<br />'~m>>Ali~Y
<br />')t:at:t' Cert. or Regist. #
<br />C:,:j,t::ir I.icense Registration t
<br />',hd~1: ';- "'****,ll-*****;:***,t*~
<br />
<br />#J..
<br />
<br />otHER_ '~
<br />Signa~-\/~ ~' '..J-.:.. ~
<br />+ *.....* 2'''''''''.
<br />
<br />c.._!P,@:_,(~f
<br />S~at~ Cert. or Regist. j
<br />';h~ License Registration f
<br />,'", '***'ll',I:-*******************
<br />
<br />APPLICATION APPROVED BY
<br />
<br />PERKIT OFFICER.
<br />
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