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<br />APPLICATION FOR PER.HIT <br />CITY OF ZEPllY:((UILLS <br />B([[LJ)ING DEPARillfiJ'.m <br /> <br />~~' (., 6 (3 <br /> <br />OWNER · S NAItE <br /> <br />B ~.tI d ~ LK <br />(, It 3 ~) <br /> <br />Q t< ~ .5 5 PIIOR <br />.__b(l~;,d -Lu('G~ <br /> <br />OWNER · S ADDRESS <br /> <br />JOB ADDRESS <br /> <br />~ <br /> <br />LEGAl. DESCRIPl'IOJli: LOT(S) <br /> <br />.__.3I..oe.: <br /> <br />SUJBDIVISION ~'I~ I\. r'-1'''l L/ Kl f(S <br /> <br />PARCEL 1. D. # <br /> <br />Lf - ,J.." - J. I <br /> <br />(JC3D <br /> <br />QC 0 c!lU <br /> <br />OO&b <br /> <br />~RK PROPOSED: j)( !Mew Construction _Addition _Alteration _Repair _Install <br /> <br />_Sign <br /> <br />_lltove <br /> <br />_DeIIOlish <br /> <br />PROPOSED USE: <br /> <br />Single Faaily <br /> <br />_KiF <br /> <br />_, o:f Units <br /> <br />_MID <br /> <br />_~rcial <br /> <br />__Indust. <br /> <br />_Swia. Pool <br /> <br />Ot:her <br /> <br />_Restaurant &: Health Departaent Approval <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />Square Feet. <br /> <br />Height <br /> <br />RESIDENTIAL: <br />COHKERCIAL : <br /> <br />ATTACH (2) PLOT PLANS &: (2) SEI'S OF BUILDING PLANS &: (1) SET RRERGY FORMS. H <br />ATTACH (3) SETS OF BlITI.DIBG PLO'S &: (1) SET ENERGY FORKS. ** <br />**COPV OF CONTRACT ~urrRED. <br /> <br />PEhmITS REOUESTED <br /> <br />_BUILDING <br /> <br />$ ~OG~'~ <br /> <br />Valuation o:f Total Construction <br /> <br />_ELECTRICAL <br /> <br />AMP Service <br /> <br />Florida Power COrp. <br /> <br />W.R.E.C. <br /> <br />_MECHANICAL <br /> <br />s <br /> <br />___..V'aJu;,t:ion o:f Mechanical Installation <br /> <br />_PLlJKBUm <br /> <br />GAS <br /> <br />ROOFIJNlG <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION!: _Block. <br /> <br />! T3Bf~ _Si:.€:.::l. <br /> <br />Uther <br /> <br />FI1'fiSHED FLOOR ELEVATIONS: <br /> <br />FT. <br /> <br />IS PROJECT IN FLOOD ZONE AREA? <br /> <br />*************~**************************** <br /> <br />YES NO <br /> <br />ClilJn'Rf\CIOR SECTION <br /> <br />L'U1fPAi1W-1lCJ""'- '- l ()~..... Po.....L.J <br />~ f'\ ~ .' _ ^ State ':;ert:. or Regist:. , cae. O~!So'''I1-- <br />Signature ~ ~ City !.icense Registration , rflo <br />****************,..*"'*;.t**1i1:il-~*****""********** <br /> <br />ET.ECI'RICIAN , aJ1f.P~(j ___ --..... ~'-c\.. ~ C-....A,.( <br />I;~. -I 'I.. /../, S~te ?ert:.. or R~gist:.. _, <br />. SiJrnature~, ~L/ C...t:y L1cense Reg1strat10n I 'rJJ uk <br />r ********"'** f:....."."'*>i'*****-:'lc******************* <br /> <br />BUILDER <br /> <br />PLmtBER <br /> <br />~~ANY <br />S t:a t:e Cert:. or Regis t:.. , <br />Cit::y'icense Registration I <br />**********-:::."::i\:**~;,"'**,.,*-lt'o: **''**'''**-It********** <br /> <br />Signature <br /> <br />KECllAMICAL <br /> <br />c:oMPA1'lIY <br />St'..ate Cert:. or Regist:. if: <br />City License Registration I <br />-It''''''-lt-lt'lt-lt*-lt'''*-lt-lt~'oo'lir*>l:--;i-*~-lt>l.-*******-lt-lt-lt****-lt***''' <br /> <br />Signature <br /> <br />0l1IER .. ~MT~/C) #~_ <br />~- State CerL or RegisL . /lY 'O1'l~'" <br />Signatur . ......_ ...~Lt:y :;',ic<:'1lSe Registration I/: oS <br />'It***-;i-**>Ii:*~ ,.,,*,* "0 .:t..':i,,g,'~**;i: J:*'l!: :?:*************"'** 0 0 .. 0 <br /> <br />APPLICAnON APPROVEn BY <br /> <br />PERKIT OFFICER.. <br />