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1 APPLICATION FOR PERKIT CI'lYOPZEPIIYRIIIU..S . BllfIIJ1UiG DEPARIIIENT , - OWNER' S lWIE ~ t \...:)G Y 0 l.U ~ \... ') ~ PROD ~ '61<) -\::) \..\5 ~ OWNER' S ADDRESS 5 ~ \ ~ ~ ~ '--L ~ \. ,0 S2> ?":.E ~ t\ Y J2-- \-\ \, \.}.S F L 5:55 ~ \ JOB ADDRESS (0 -;).~~ CO \ L\J ~-' ~, a ~ \.:L S D ~ LEGM. DESCRIPJ'IOlI: Im(S) \ \ to BUJ(Z - SDBDIVISIOII~\\..\)P~~ ()~~ ~\-\ l il PARCEL I.D.' S - d..\o - ~ \ - ~\cl-.C) -~~~~ - \ tlo 0 - IIDRJ( PROPOSED: ~ev Construction _Addition _Alteration _Repair _Install S. _!!love _De.o1ish - 19I1 PROPOSED USE: ~ing1e Paai1y _KIF _, of Units _K/B _~rcia1 _Indust. _Swill. P001 Other _Restaurant 6: Bea1th Depar~t Approva1 " 1 BUILDING SIZE: :=:;Ct33~. 'd(1~ct \.-..'0 Square peet._l G Beight RESIDENTIAL: A'ITAaI (2) PLOT PLUS 6: (2) SEI'S OF BUIl.DING PLUS 6: (1) SEI' ENERGY FORMS. ** COHIIERCIAL: ATI'AaI (3) SILTS OF BUIl.DI8G PLUlS 6: (1) SEI' EIIERGY JIORHS....... ......mpy OF mllTRACT BIlQUIlUlD. PERKITS REOOFSTED x: BUlLDIIiG VKLECl1UCAL ~CAL ~ PLOtIBING $Co5~~~ .. \. '5 CJ s 3(j~ .. Va1uation of Tot:a1 Construction AtIP Service V P10rida Power Corp. W.R.E.C. Va1uation of Kecbanica1 Inst:allation GAS HOOFING SPECIALTY TYPE OP mIiSTRUC'I'ION: ~B1oclt _Pra.e _Stee1 Other FDIISIIED FLOOR ELEVATIOJJS: 0t Cl $- FJ' . IS PROJECT IIi FLOOD ZOIiE AREA'! v YES NO .............................................................................................................................. RIJTI.DY.R Signature~ CDn'KACIOR SECJ'ION COlIPANY R \ c:.... .. )s, \)~b\\ t::;.. ~' Sl:ate Cert. or Regist. , C. ~,~C>) C~C)~ ~ City License Registration , 3/9' ............................................................................................................................ F.T.P.cnrrCIAN COlIPMY f t~ S L~~\' ~ \. C- ~~::J~.) ~~ 'f: S~t:e ~rt. or R~gist. -' ~ D(')~ \.U~'-\ ~ I ,'-. ~ 0 - C1t:y L1cense Reg1Strat:1on , -StJ -- '" ........................................................................................................................ PLOIIBER COlIP~~~Q:Bw~~, ~ ~:::>L'\5~ ~\ _ \\ \ Sl:ate Cert. or Regist:. t Signature ~t } \J\\~ City License Registration , 1 rt "S ............................................................................................................................ ~ COlIPMY.~J ~-- \ ~ ~ Sl:ate Cen:. or Regist. , City License Registration , .............................................................................................................................. ItEalARICAL Signature J ~ / < y 0T1IF.R COlIPOY Sl:ate Cert:. or Regist. , Signature City License Registration I .............................................................................................................................. APPLIc&nOR APl'IIlWED BY 2/ ~ oJf. a/lAhJ PI!IlIIlY OFFICER.