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<br />APPLICAnON FOR PERKIT <br />CITY OF ZEPIIYRBILLS <br />BUILDING DBPARTtIERT <br /> <br />OWNER' S JWtK /I11~ -.( rn RS A f, t"l vd, <br />, <br /> <br />OWNER'S ADDIlBSS r.; 1 C> :l P l. ~. <;~ ~/U7 <br /> <br />PHONE <br /> <br />JOB ADDRESS <br /> <br />-5:4/17 L <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />PARCEL LD.' <br /> <br />(OBTAIN FROM PROPERTY TAX NOTICE) <br /> <br />WORK PROPOSED:~ew Construction ~ddition --Alteration ---ltepair _Install <br /> _Sign --lIove ---.J)eaolish <br />PROPOSED USE: -5iogle Faaily ---1I/F _' of Units ---1I/H <br /> _ec-ercial _Indust. _Swill. Pool _Other <br /> <br />--.-..Restaurant &; Health Departaent Approval <br /> <br />DESCRIPTIOR OF WORK: <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />Square Feet, <br /> <br />Height <br /> <br />RESIDEIITIAL: <br />COtlKERCIAL : <br /> <br />ATTACH (2) PLOT PLARS &; (2) SETS OF BUILDIRG PLANS &; (1) SET EBERGY FORMS. <br />ATTACH (3) SETS OF BUILDING PLANS &; (1) SET ERERGY FORHS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CORSTRUCTION. <br /> <br />PERMITS REOUESTED <br /> <br />\ I <br />...l:.-BUILDING <br /> <br />~ <br />$ //0(":' '- <br /> <br />Valuation of Total Construction <br /> <br />RT.RcrBI.CAL <br /> <br />AHP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />----lIECIIAlIICAL <br /> <br />$ <br /> <br />Valuation of Hechanical Installation <br /> <br />~UKBING GAS ROOFING <br /> <br />SPECIALTY . <br /> <br />TYPE OF COIISTRUCTIOR: .--.Jloclt _FraIIe _Steel <br /> <br />Other <br /> <br />FDlISBED P.WOR ELEVAnOIllS: <br /> <br />FT. <br /> <br />IS PROJECT I.R FLOOD ZORE AREA., <br /> <br />YES NO <br /> <br />.......................................... <br /> <br />CONTRACTOR SECTION <br /> <br />RUTT.DER .:~ ~/2 1.2'/111'(,'.. ,.. .:'. '. 'maPARY 5fi'ti? ~ <br />//t:.<~ It' ~Xl:::.AW'-"'..,.'"7 <br />. )J,'. . . - - . State Cert. or Regist. . <br />signatureg}lc'!..:):J/:nVYlS Co,tt.J9~u:1-,c,,'~City License Registration . <br />.......................................... <br /> <br />.:L~Y <br /> <br />RT.RCTRICIAIlI COMPANY <br />State Cert. or Regist. . <br />SianAture City License Registration . <br />.......................................... <br /> <br />PLUMBER COKPARY <br />State Cert. or Regist. . <br />Signature City License Registration . <br />.......................................... <br /> <br />tlECllARI.CAL COMPANY <br />State Cert. or Regist. . <br />Signature City License Registration f <br />.......................................*.. <br /> <br />OTRRR COMPANY <br />State Cert. or Regist. . <br />Signature City License Registration . <br />...............*.......................... <br /> <br />APPLICATIOR APPROVED BY PERKIT OFFICER. <br />