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<br />APPLICAnON FOR PERKIT <br />CITY OF ZEPIIYIUIILLS <br />BUILDING DEPARTKERT <br /> <br />OWNER'S IiAHB <br /> <br />111 P.. ~ rn /2...S <br />SoI..S-S- <br /> <br />. ~ ;;..S"S <br /> <br />Wi wI) Ross <br />~ t-H S T <br />7/ r-J-j <;; r . <br /> <br />PHONE gfl 3 - 7 g-d - 7.3 9<::f <br /> <br />OWNER'S ADDRESS <br /> <br />JOB ADDRESS <br /> <br />LEGAL DESCR.I.P'l'ION: LOT(S) <br /> <br />BLOCIL.--SUBDIVISION <br /> <br />PARCEL LD.' (OBTAIN FROH PROPERTY TAX NOTICE) <br />WORK PROPOSED:____ew Construction ---..Addition ~teration --.Jtepair _Instal.l <br /> <br />_Sign <br /> <br />-.JIove <br /> <br />-Peaolish <br /> <br />PROPOSED USE: ~ingle Faaily <br /> <br />---.Jt/F _' of Units ---.Jt/a <br /> <br />_ec-ercial <br /> <br />_Indust. _Swia. Pool _Other <br /> <br />Restaurant &: Health Departaent Approval <br /> <br />DESCRIPTIO. OF WOH: -::r: I1.J STY#- )... L 1--/12- lA- '( <br /> <br />.pu~ <br />, <br /> <br />BUlLDIMG SIZI: X Square Feet, <br /> <br />Height <br /> <br />RESIDEIITIAL: ATTACH (2) PLOT PLANS &: (2) SETS OF BUILDING PLAHS &: (1) SIT ENERGY FORMS. <br />COIIKERCIAL: ATTACH (3) SETS OF BUILDIRG PLAHS &: (1) SET ENERGY FORKS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PERMITS REOUESTED <br /> <br />-BUILDIRG <br /> <br />$ <br /> <br />Valuation of Total. Construction <br /> <br />Rl.RcrJlICAL <br /> <br />/')0 AIIP Service ./' Florida Power Corp. <br />03 <br />$ ;).. / J D Valuation of Hechanica1 Installation <br /> <br />W.R.E.C. <br /> <br />-lIECllARICAL <br /> <br />--PLUHBIRG <br /> <br />GAS <br /> <br />ROOFING <br /> <br />SPECIALTY . <br /> <br />TYPE OF COIISTRUcnON: ~1ock -Fraae _Steel <br /> <br />Other <br /> <br />FDlISHED F1OOB. ELEVAnONS: <br /> <br />Fl. <br /> <br />IS PROJECT III FLOOD ZOIlE AREA' <br /> <br />.......................................... <br /> <br />YES NO <br /> <br />CONTRACTOR SECTION <br /> <br />o. <br /> <br />Bml.DER <br /> <br />,., <br /> <br />Signature <br /> <br />.cdHPARY <br />State Cert. or Regist. . <br />City License Registration . <br />~.........................."............. <br /> <br />COMPANY I (oq Rill lZ L~ C <br />State Cert. or Regist.' E" ([(JQ ll. l ~ ~ <br />City License Registration' J....3 I <br />.......................................... <br /> <br /> <br />PLUMBER <br /> <br />COHPARY <br />State Cert. or Regist.' ~ ~ <br />City License Registration . <br />.......................................... <br /> <br />Signature <br /> <br />... <br /> <br />IlECllANIGAL COHPABY SouTH ERv c.o~~te...r ~ T <br />State Cert. or Regist.' R JIYI ()C IS Q 2.. L <br />Sigoature City License Registration f ~1 <br />.......................................... <br /> <br /> <br />OTRRR COHPARY <br />State Cert. or Regist. . <br />Signature City License Registration . <br />.......................................... <br /> <br />APPLICATION APPROVED BY PERKIT OFFICER. <br />