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<br />APPLICATION FOR PERftIT <br />CITY OF ZEPIIYRBILLS <br />BUILDING DEPARTItEBT <br /> <br />OWNER · S RAIlE <br /> <br />Ct") (d ~rJ <br /> <br />(!o/G~~L <br />a ~ /I SIr/d. <br />(JAil lJ/vd, <br /> <br />PHONE <br /> <br />766J}Sso <br /> <br />OWNER' S ,ADDRESS $ I ,i () <br />JOB ADDRESS 5.- I 3D <br /> <br />'z- H FL <br />Z.//, FL. <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />B~SUBDIVISION <br /> <br />PARCEL LD.' <br /> <br />WORK PROPOSED:_New Construction _Addition _Alteration ~epair _Install <br /> <br />_Sign <br /> <br />_Rove <br /> <br />_Deaolish ~f/\ f.\N~e-- CJG.l"r' Ifl~ <br /> <br />PROPOSED USE: <br /> <br />Single FMlily <br /> <br />-"IF <br /> <br />_, of Units <br /> <br />_RIB <br /> <br />_~ercial <br /> <br />_Indust. <br /> <br />_SII18. Pool <br /> <br />Other <br /> <br />_Restaurant & Bealth DepartJIent Approval <br /> <br />~re Feet, <br /> <br />Beight <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />RESIDENTIAL: <br />cotUtERCIAL : <br /> <br />ATI'ACII (2) PLOT PLUlS & (2) SETS OF BUILDING PLARS & (1) SET ENERGY FORKS. <br />ATI'ACII (3) SEtS OF BUILDING PLANS & (1) SET ENERGY FORKS. <br />PImPERTY SURVEY REQUIllRD FOR ALL ImW WNSTRUCTION. <br /> <br />PERKITS REQUESTED <br /> <br />_BUILDING <br /> <br />$ <br /> <br />Valuation of Total Construction <br /> <br />_ELEcnuCAL <br /> <br />AIIP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />_~...JmCBAliICAL <br /> <br />$ <br /> <br />Valual:ion of tlecbanical Installation <br /> <br />_PLOHBIBG <br /> <br />GAS <br /> <br />ROOFIliG <br /> <br />SPECIALTY <br /> <br />TYPE OF WNS'lKUCtION: _Block _FrMle _Steel <br /> <br />Other <br /> <br />FIIUSBED FLOOR ELEVATIONS: <br /> <br />FI' . <br /> <br />IS PRO.JECl" IN FLOOD ZONE AREA? <br /> <br />YES NO <br /> <br />****************************************** <br /> <br />WNl'RACfOR SECl'ION <br /> <br />BUILDER <br /> <br />Signature <br /> <br />cotIPAIIY <br />State Cert. or Regist. , <br />City License Registration , <br />****************************************** <br /> <br />F.T.F,cnuCIAII <br /> <br />COItPAIfY <br />State Cert. or Regist. , <br />City License Registration , <br />****************************************** <br /> <br />SiPTI~ture <br /> <br />PLUKBER <br /> <br />Signature <br /> <br />COtIPARY <br />State Cert. or Regist. , <br />City License Registration , <br />****************************************** <br /> <br />Signature <br /> <br />r;o 1~ <br /> <br />COItPARY 2* ~ <br />State Cert. or Re ist.' R 80 se> 8 if <br />City License Registration , BCd <br />****************************************** <br /> <br />IlECllARICAL <br /> <br />OTRF.R <br /> <br />COItPARY <br />State Cert. or Regist. , <br />City License Registration , <br />*.~****************************.********** ' <br /> <br />Signature <br /> <br />APPLICATIOR APPRoVED BY <br /> <br />'1d~q <br /> <br />:>lJ 1~"vrr-- <br />- <br /> <br />, nmnT OFFICER. <br />