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<br />APPLICATION FOR PERKIT <br />CITY OF ZEPIIYRBI.I.lS <br />BUILDING DEPAR.1lIEIiT <br /> <br />OWNER'S lWtE r4 G L L Y kl, 2, M M ~ J2.... <br />OWNER' S ADDRESS ~ t~ '7 a t:t bA- Do WOCl D <br />- <br /> <br />JOB ADDRESS ~ 1 r.r- <br /> <br />0017 <br /> <br />PHONE ~ l,~ -7Z8 -,.:) Df:;-} <br />Zer~vh \ ) \.... '-J I .33 ~o <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />PARCEL 1.0.' <br /> <br />I.?> -ril{'l-aJ -D(4l) -oOOoo-o~'to <br /> <br />WORK PROPOSED:_Nev Construction _Addition _Alteration _Repair _Install <br /> <br />_Sign <br /> <br />_Hove <br /> <br />_DeIIolish <br /> <br />PROPOSED USE: <br /> <br />Single Fmlily <br /> <br />_H/F <br /> <br />_' of Units <br /> <br />_HIH <br /> <br />_ec-ercial <br /> <br />_Indust. <br /> <br />_Swia. Pool <br /> <br />Other <br /> <br />_Restaurant 6: Health Depar~t Approval <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />~re Feet. <br /> <br />Height <br /> <br />RESIDENTIAL: <br />COfIHERCIAL : <br /> <br />ATrACH (2) PI..OT PIARS 6: (2) SETS OF BUILDING PLAliS 6: (1) SET ENERGY FORMS. <br />ATrACI (3) SETS OF BUILDING PLANS 6: (1) SET ENERGY FORMS. <br />PROPERTY SURVEY REQUIRED FOR ALL IiEW CONSTRUC'l'ION. <br /> <br />PERKITS REOOESTED <br /> <br />_BUILDING <br /> <br />$ <br /> <br />~oo . 0 D <br /> <br />Valuation of Total Construction <br /> <br />_ELECI1UCAL <br /> <br />AIIP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />_HECBARICAL <br /> <br />$ <br /> <br />Va1uation of Hechanica1 Inst:a1lation <br /> <br />_PLUHBING <br /> <br />GAS <br /> <br />ROOFlliG <br /> <br />SPECIALTY <br /> <br />TYPE OF COtiS'lKUCl'ION: _Block _Fralle _Steel <br /> <br />..,/" <br /> <br />Other <br /> <br />FINISHED FLOOR ELEVATIONS: <br /> <br />FI' . <br /> <br />IS PROJECI' IN FLOOD ZONE AREA? <br /> <br />YES NO <br /> <br />****************************************** <br /> <br />GONTRAcroR SECI'ION <br /> <br />BUILDER <br /> <br />COItPANY <br />State Cert. or Regist. , <br />City License Registration , <br />****************************************** <br /> <br />Signature <br /> <br />F.I.ECI1UCIAIi <br /> <br />COMPANY <br />State Cert. or Regist. , <br />City License Registration , <br />****************************************** <br /> <br />Sirm~ture <br /> <br />PLUHBER <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration , <br />****************************************** <br /> <br />Signature <br /> <br />MECHANICAL <br /> <br />COMPANY <br />State Cert. or Regist. , <br />City License Registration , <br />****************************************** <br /> <br />Signature <br /> <br />OTRF.R <br /> <br />COMPANY <br />State Cert. or Regist. , <br />City License Registration , <br />****************************************** <br /> <br />Signature <br /> <br />APPLlCAnON APPROVED BY <br /> <br />PERKIT OFFICER. <br />