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<br />APPLICAnOli FOR PERllIT <br />CIlT OF l.ItPulKH H.Le; <br />BUll.DI1iG DEPARIIIRIn' <br /> <br />OWNER I S IiAItE <br /> <br />P-VE/(E 1r <br /> <br />GAiL vfJ <br />H~NErf /Jr. <br /> <br />JIIIOlIE 780 -C / II <br /> <br />OWRER I S ADDRIrSS .58 7 S-o <br /> <br />JOB ADDRESS <br /> <br />SA J1E- <br /> <br />LEGAL DESCllIPI'IOII: UJI'(S) <br /> <br />/5" <br /> <br />.BLOCIL-SOBDIVlSIOIl PAy k H /). L S" uft <br /> <br />PARCEL LD.' 0,," - ~C - '-I - 0 I go - CJdCJ(JO <br />WRK PROPOSED:_lIev Construction / Addition <br /> <br />ClI("d <br />/ Alteration _Repair _Inst:all <br /> <br />_Sign <br /> <br />_!!love <br /> <br />_De.o1ish <br /> <br />PROPOSED USE: <br /> <br />/Single Fam.1y <br /> <br />_fl/F <br /> <br />_, 0:( Units <br /> <br />_M/H <br /> <br />_~rcia1 <br /> <br />_Indust. <br /> <br />_Swi8. P001 <br /> <br />Other <br /> <br />_1Iest:auran.t 6: Bea1th Departaent Approva1 <br /> <br />BUILDIIIG SIZE: <br /> <br />x <br /> <br />~e Feet. <br /> <br />Height <br /> <br />RESIDENTIAL : <br />aJIIIIEKCIAL : <br /> <br />A'lTAaI (2) PIJJI' PIAIIS 6: (2) SEIS OF BOII.DIlIG PIAliS 6: (1) SET ElIERGY FORtIS. ** <br />ATrAaI (3) SEIS OF BOII.DIlIG PIAIIIS 6: (1) SKI' ElIERGY FUBIIS.** <br />**oopy OF oollTKAct RIIQUIRIID. <br /> <br />PIr.RII11S REOUESTED <br /> <br />----..BUILDING <br /> <br />$ /~ s/t.cd <br /> <br />Va1uation 0:( Tot:al Construction <br /> <br />RI.RcnuCAL <br /> <br />AIIP Service <br /> <br />F10rida Power Corp. <br /> <br />W.R.E.C. <br /> <br />--.JIECIIAIITCAL <br /> <br />$ <br /> <br />Va1uation 0:( Mecbanica1 Inst:a1lation <br /> <br />_PLUttBING <br /> <br />GAS <br /> <br />KOOFDiG <br /> <br />SPECIALTY <br /> <br />TYPE OF OOIlSTKUCTIOIl: ----..B1ock _Fra.e -L.Stee1 <br /> <br />ilL (/1'1. <br /> <br />Other <br /> <br />FIlIISHED FLOOR ELEVATIOIIS: <br /> <br />n. <br /> <br />IS PROJECI' III fiOOD ZOIlE AREA? <br /> <br />YES NO <br /> <br />*****..*********************************** <br /> <br />RUTT .DO <br /> <br />aJIIDL\CIOR SECJ'IOR <br /> <br />COIPAIIY Ji /;..roN t:,aN5r. <br />f)~ ,P--I/, .'" State Cere:. or Regist. t R.B. ot:JlotJ 7C <br />/Sa ~ ~ City License Registration' i~ <br />. ***********************..***************** <br /> <br />Signature <br /> <br /> <br />WllPAIIY Fr '/z- 5 r (?~, s s F leCi~ :~ <br />State cert:. or Regist. t' ~ ~ ~ c:-/ "'7 v <br />City License Registration t / <br />****..*******..**************..****** <br /> <br />PLOIIBER WllPAlIY <br />State Cert:. or Regist. t <br />Signature City License Registration t <br />**********************..****************** <br /> <br />IIECBAlIICAL WllPAIIY <br />State Cert:. or Regist. t <br />Signature City License Registration t <br />***********..*..*********************..*** <br /> <br />0T1I1tR WllPAlIY <br />State Cert. or Regist. t <br />Signature City License Registration t <br />*..*******..****..************************ <br /> <br />APPLICATIOIl APPROVED BY PERIIIT OFFICER. <br />