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<br />II -;l 9-. 7' 7' <br />/: ~~?/f <br /> <br />APFI.lGATION FOR PKllKIT <br />(:IU 0... ZRFHYlUllLLB <br />BUILDlNG DRPARTKRNT <br /> <br />OWND · 5 NAHRW,l}d ~ mer .J.kQj{S % /J?S. ?'S(" II (~ <br />LJ I71L f?odd JJ . P. R ~ 3t/f...-.J -I <br />JOR ADJ)R8SS~ (; t1().. I S; I Ve If!. O~ <br /> <br />I.RGAL DBSClUl"TlOR: LOT(S) 11'7 11 BLO<'''R,OOOOOSUBDIVl9IOH <br />~-U~ ~,- ~ 1~ -.((bXX)J 11jk <br /> <br />PHONE <br /> <br />7lH -FL/-/-8WY <br /> <br />OWRER' S AJ)I)USS_~ 7d< a I <br /> <br />010l. IJ . <br /> <br />~ian <br /> <br />-1tOve <br /> <br />-.J>etIOl ish <br /> <br />PROPOSIID Wlh ~ing1e F&ally <br /> <br />----1'11 F <br /> <br />_' of Unit. <br /> <br />i ~ ,./1'11<- <br />entfV I <br />_Other pe(r( <br />~I <br />scrt{/1 i;ne)oSur<2-WJlJJ <br /> <br />----1t/8 <br /> <br />~~('ct.l _lndu8t. ~ V"Swia. Pool <br /> <br />--1le8buu:ant &, Bulth Dflpartaf'!~t Approvl.ll ~d) <br /> <br />DESmuPTlOI OP WORk! f1J91t>/J./Id ,SuJIMIhI.vJ poaL-~ 4 <br />\ ; I,,, <br />BUILDING SUI, .-1.2 x_~ '1. SqUAlr:e Feet. Be1pt <br /> <br />us IDBIIT1AL! <br />COKI1D.OIAL ; <br /> <br />ATTACH (2) PLOT PLANS & (2) S8TS OF BUILDlMG PLANS & (1) SIT ENEROY FORHS. <br />ATrAaJ (3) SBTS OF BUILDING PLANS" (1) SRT RNERGY FORMS. <br />PROPERTY 8U1tVIT Rl<<lUllUID FOR ALL NEW CONSTRUCTION. <br /> <br />P.qaITS UOUISTU <br /> <br />____BUlLD1J1G <br /> <br />$.~tOIS,60 <br /> <br />Va.lut1on ot Totel Con8tru~tion <br /> <br />~1...BC11llCAL <br />__...JtRCRUlCAL <br /> <br />NIP Sf!rvlee <br /> <br />.Florida Powl9r Corp. <br /> <br />_w.R.e.c. <br /> <br />* <br /> <br />Valuation of "@chenie.l Installation <br /> <br />_YUllBIIG <br /> <br />GAS <br /> <br />ROOFiNG <br /> <br />SPBClALTY <br />Gd(\\\e.. <br /> <br />Oth~r <br /> <br />nrlJ OF OOWSD.UCTIONI ---"lock <br /> <br />_Ftaa@ _St@f!l <br /> <br />FUlSBP nooa BLBVATIONS' <br /> <br />n. <br /> <br />IS PROJECT IN FLOOD ZONR AlBA, _ <br />YES NO <br /> <br />.......................................... <br /> <br />IQJ ItP~ <br /> <br /> <br />.GON'l1L\laQJl SEL". pH <br /> <br />.AMY S I~ /lo <br />State Oert. Qr leaiat. . <br />City License Real.t~.tloD . <br />.......................................... <br /> <br /> <br />. ~ <br /> <br />COKPANY'~ /JLl- bin? t1(f:i-riC <br />:~ ."to c..t. or ....10.. . <br />.~ -- City License ReahtraUOD , <br />.......................................... <br /> <br />IW'QI COttPANY~t04~ ~o,~~c. <br />~ s.... Con. or ..,I.t.' ('if'!o~ ~ril9 <br />Slanotut@ ~-- City Licens@ Re.iBtration . _..1 '-I <br />~.................*......t............. ' <br /> <br />:lIT <br /> <br />- <br /> <br />~lCAL COHPANY~, <br />State CerL. or Real.t. f <br />Stgo.etuct! __ City Lic.osf! lteat9tratloo . <br />.......................................... <br /> <br />amBll COMlANr <br />S~te O4lct. or Re8ht. . <br />Slgnatur@ r ,~ City Lteeose Ileahtration . <br />.It....................................... <br /> <br />APPI.ICATION APP1l0VlW BY PBRKlT OFPIOO. <br />