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<br />APPLICA.nOll FUR PERKlT <br />GI'IY OF ZEPIIYRIllLLS <br />BUII.DlliG DEPARlluulI <br /> <br />~o ])rYlJ/n~ <br />IC~ ~ 1% <br />~C; /(0 /y , / /t2w <br /> <br />LEGAL D&<<iCRIPl'IOII: UJI'(S) ~SUBDIVI.SIOII <br /> <br />OWNER · S RAIlE <br /> <br />PROD <br /> <br />73tJ - /l if9 <br /> <br />OWNER' S ADDRESS <br /> <br />JOB ADDRESS <br /> <br />7<V H;rL <br /> <br />J <br /> <br />PARCEL I.D.' / <br />WORK ~POSED:~ Construction <br />_Sign <br /> <br />_Addition ----Alteration ____..Repair _Install <br /> <br />_Move <br /> <br />_ne.ol.ish <br /> <br />PROPOSED USE: , .../ Single F_ily <br /> <br />_ft/F <br /> <br />_' of Units <br /> <br />-----1118 <br /> <br />_~rcial <br /> <br />_Indust. <br /> <br />_Swbl. Pool. <br /> <br />Other <br /> <br />BUILDING SIZE: <br /> <br />____..Restaurant &- Hea1.th Deparment Approval <br /> <br />,5 (D f <br /> <br />J 0 x3 ( . <br />, <br /> <br />Square Feet. <br /> <br />/ '(0 '( <br /> <br />Height <br /> <br />RESIDENTIAL: <br />cotIIIERCIAL : <br /> <br />A1TAaI (2) PI.OI' PLAIIS &- (2) SKIS OF BUll.DIRG PLAIIS &- (I) SEt' ElIERGY FORIIS... <br />A1TAaI (3) SKIS OF BUII.DIIIG PLAIIS &- (1) SEt' ElIIIRGY fURIIS... <br />..mpy OF mll'J"KAGr 1UlQU1JUID. <br /> <br />,. <br />/ <br />/ <br />J"BUlLDING <br /> <br />t - 0::'--- PIlIIIIt]li IlIlIIIIJl.~J'llII <br />J !JU - Valuation of Total <br />( <br /> <br />Construction <br /> <br />$ <br /> <br />_ELECTIUCAL <br /> <br />Aftp Service <br /> <br />Fl.orida Power Corp. <br /> <br />W.R.E.C. <br /> <br />----.J[ECIIARlCAL <br /> <br />$ <br /> <br />Valuation of ftechanica1 Installation <br /> <br />-PLUllBIBG GAS ROOFIBG <br /> <br />SPECIALTY <br /> <br />TYPE OF mNSTRUC'I'IOB: ---..Bl.oclt -.Fo.e _Steel. <br /> <br />Other <br /> <br />FINISHED FLOOR ELEVATIOIIS: <br /> <br />FI' . <br /> <br />IS PROJEGr IN FLOOD :milE AREAT <br /> <br />YES NO <br /> <br />.......................................... <br /> <br />BUTT.DER <br /> <br /> <br />WDRACIOR SECI'IOR <br /> <br />lDIPMY ~~Ar:~ ;jIJrnm rlfV/ <br />State Cert. or Regist. . ~~) c.J3C-oc9~t' 717 <br />City License Registration t c2 g' P <br />............................. <br /> <br />Signature <br /> <br />RI.RCTRTCIAB <br /> <br />aJIIPAIIY <br />State Cerl:. or Regist. f <br />City License Registration . <br />.......................................... <br /> <br />SiDDAture <br /> <br />PIJIIIRItR <br /> <br />aJIIPMY <br />State Cert. or Regist. t <br />City License Registration t <br />.......................................... <br /> <br />Signature <br /> <br />fIItaIAJIICAL <br /> <br />aJIIPMY <br />State Cert. or Regist. t <br />City License Registration . <br />.......................................... <br /> <br />Signature <br /> <br />OTRIlR <br /> <br />CDlPABY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />Signature <br /> <br />APPLlCAnOB APPROVED BY <br /> <br />PElUllT OFFICER. <br />