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<br />APPLICATION FOR PERKIT <br />CITY OF zEPIIY1UI1LLS <br />BUILDING DEPARTKENT <br /> <br />OWNER'S ADD1lESS <br /> <br />ISIO <br /> <br />8 Vt. L-L (;) CJrC-. <br />D~'7"E ~/ <br /> <br />OWNER'S IiAHE <br /> <br />\I/Yo E. <br /> <br />JOB ADDRESS 5"~ / 5 - S-S? i 7 <br />LEGAL DESCRIPTlON: LOT(S) <br /> <br />I') Ut <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />PARCEL I. D.' (OBTAIN FROM PROPERTY TAX NOTICE) <br />WORK PROPOSED:_New Construction .-Jddition .-Jlteration _Repair X Install <br /> <br />_Sign <br /> <br />----ll<>ve <br /> <br />_Deaolish <br /> <br />PROPOSED USE: 2:!:......Single Faaily <br /> <br />---Yt/F _' of Units _K/H <br /> <br />_ec-ercial <br /> <br />_Indust. _Swia. Pool _Other <br /> <br />___estaurant Ii Health Departaent Approval <br /> <br />DESCRIPTIOli OF WORK: <br /> <br />'T Efli<- C) FF ,,/-f) M"f:-,...-..r 1- , /,IV<;/'t1'-I.- <br />) <br /> <br />f 18 ea tf-/...IJ5 S S If I/V 6-- t.E a. 0 d" p.. <br /> <br />BUlLDlliG SIZE: <br /> <br />x <br /> <br />I :2.. J {) () Square Feet I <br /> <br />Height <br /> <br />RESIDEBTIAL: <br />COMMERCIAL : <br /> <br />ArrACK (2) PLOT PLANS Ii (2) SETS OF BU1LDIliG PLANS Ii (1) SET EliERGY FORMS. <br />ArrACII (3) SETS OF BUlLDlliG PLANS Ii (1) SET ENERGY FORMS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PERKITS REQUESTED <br /> <br />_BUlLDlliG <br /> <br />$ .2.5 00,00 <br /> <br />Valuation of Total Construction <br /> <br />JU,F.crRICAL <br /> <br />AIIP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />--1IECIWI1CAL <br /> <br />$ <br /> <br />Valuation of Mechanical Installation <br /> <br />_PLUMBlliG <br /> <br />GAS <br /> <br />x <br /> <br />ROOFING <br /> <br />SPECIALTY . <br /> <br />TYPE OF COliSTRUC'fiOli: _Block _Fraae _Steel <br /> <br />Other <br /> <br />F1BlSBED FLOOR ELBVAfiOI1S: <br /> <br />Fr. <br /> <br />IS PROJECT lli FLOOD ZONE AREA? <br /> <br />YES NO <br /> <br />.......................................... <br /> <br />coNTRACTOR SECTION <br /> <br />cOKPARY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />BUTl,mm <br /> <br />Signature <br /> <br />SianAture <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />1U .R.CTR.ICIAII <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />PLUMBER. <br /> <br />Signature <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />MECHARICAL <br /> <br />Signature <br /> <br />Signature <br /> <br />,/~ ~ /h/L, <br /> <br />COMPANY fA. 0 ..-vr ~ U j' J, /L11 L. '- J;/<... / /V C-. <br />State Cert. or Regist.' c.el:. O~I f~6 <br />City License Registration' #- '1 <br />...............**.**********.************* <br /> <br />flTRF.R <br /> <br />APPLICATION APPROVED BY <br /> <br />PERH1T OFFICER. <br />