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<br />APPLiCA"tIl;~ FOR l"ERHTT <br />CITY OF ZE:PJErfllliILLS <br />BmI.DIJiG DEPAR'tHEln' <br /> <br />~~N. CONl I?~De!. P'~IZM If1f 41 ~ B ' <br /> <br />OWER'S NAME <br /> <br /> <br />PIlONE <br /> <br />OWNER · S <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />PARCEL 1. D" # <br /> <br />WORK PROPOSED:_New Construction _Addition LAlteration _Repair _Install <br /> <br />_Sign <br /> <br />_Hove <br /> <br />_De.-olish <br /> <br />PROPOSED USE: Single Faaily <br />L~rcial <br /> <br />_KIF <br /> <br />_, of Units <br /> <br />_KID <br /> <br />_Indust. <br /> <br />_Ston.." Pool <br /> <br />Other <br /> <br />_Restaurant &: Health Deparblent Approval <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />Square Feet, <br /> <br />Height <br /> <br />RESIDENTIAL : <br />cottKERCIAL : <br /> <br />ATTACH (2) PLor PI..fUiIS &: (2) SEIS OF BlITLDING PI..fUiIS &: (I) SET ENERGY FORKS. u <br />ATTACH (3) SEI'S OF BUILDING PLUS &: (1) SET ENERGY FORKS. ** <br />u'COPY OF COltfi'RAcr REQrnt'RIlD" <br /> <br />PERKITS REQUESTED <br /> <br />_BUILDING <br /> <br />$ <br /> <br />ValolJ3tioc. of To1:a1 Construction <br /> <br />_ELECTRICAL <br /> <br />AKP Service <br /> <br />Florida Power COrp. <br /> <br />W.R.E.C. <br /> <br />-"ECllARICAL <br /> <br />s r2~5.- ;-zt-;;J I I/O Valuation of Mechanical Installation <br />., <br /> <br />_PLUMBING <br /> <br />GAS <br /> <br />___ROOFING <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION: _Block _Fra!~ /Steel <br /> <br />Other <br /> <br />FINISHED FLOOR ELEVATIONS: <br /> <br />FI' . <br /> <br />IS PRO..JEcr IN FLOOD ZONE: AREA? <br /> <br />YES NO <br /> <br />***************~*******~****************** <br /> <br />WliTRACIOR SHCI'lON <br /> <br />BUI.I.DER <br /> <br />COIIPMIIY <br />State Cert" or Regist" , <br />City License Registration , <br />****~*~~**~***.*******~******************* <br /> <br />Signature <br /> <br />ELECTRICIAN <br /> <br />C~ARY <br />::tat.e Cer!:. or Regis!:. , <br />City License Registration 41 <br />****************************************** <br /> <br />Sifmature <br /> <br />PLUKBER <br /> <br />COHPANY <br />S~te Cert. or Regist. , <br />~-_.._.___.____. u'__ .:':it.y License Registration 41 <br />*********~~***********~~*~*****~~~~~:::~~~ <br /> <br />Signature <br /> <br />KEC'BABICAL <br /> <br />COIfPARY <br />State Cert. or Regist. , <br />City License Registration I <br />****************************************** <br /> <br />Signature <br /> <br />OTHER <br /> <br /> <br />OOlIPMY--I(.oDAt-.! f1 ~ 0 ~k L--eR:S l N6. <br /> <br />taLe Cer!:. or Regis!:. I Do."q~QQ.f1Qlli <br />City License Registration I --.!/f-J ~~A lA,~ <br />************************************ . <br /> <br />Signa t:ure <br /> <br />APPLICATION APPROVED BY <br /> <br />PERltI'I OFFICCR. <br /> <br />fw~t7A MtCD l{kV <br />0--4(i)/q4 <br />