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<br />APPLICATION FOR PERKlT <br />CITY OF ZEPIIYRIIILLS <br />BUILDING DBPARTHENT <br /> <br />OWNER'S IiAHE <br /> <br />D/ftA/E- <br />87957 <br /> <br />iJ H J~CD' <br />IT , u_ <br />t/w;. 5<f 0" <br /> <br />PHONE <br /> <br />lW (p 7;2..2.. <br /> <br />OWNER'S ADDIlBSS <br /> <br />JOB ADDRESS <br /> <br />LEGAL DBSCRIP'rION: I.DT(S) <br /> <br />BI.OCIL--.SUBDIVISION <br /> <br />PARCEL 1.D.' <br /> <br />(OBTAIN FROM PROPERTY TAX. NOTICE) <br /> <br />WORK PROPOSED:-"ew Construction ~ition ---^lteration --.-.Repair _Install <br /> <br />_Sign <br /> <br />--.JIove <br /> <br />-->>eaolish <br /> <br />PROPOSED USE: ~ing1e F_ily <br /> <br />--.Jt/F _' of Units ---.Jt/H <br /> <br />_ec-ercial <br /> <br />_Indust. _Swia. Pool _Other <br /> <br />" ----Restaurant Ii Health Departaent Approval I? <br />DESCRIPTION OF WOlUC: ~ ~fdf, lfvlo I ~ P;f.;) S~ <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />. <br /> <br />Square Feet, <br /> <br />Height <br /> <br />RESIDEIITIAL: <br />COtlKERCIAL : <br /> <br />AtTACH (2) PLOT PLAliS Ii (2) SETS OF BUILDING PLAliS Ii (1) SET ENERGY FORMS. <br />AtTACH (3) SETS OF BUILDING PLAliS Ii (1) SET EliERGY FORtIS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW COIISTRUCTION. <br /> <br />----BUILDING <br /> <br />$ <br /> <br />~. -cJD <br />(J 5 )Cv <br />, <br /> <br />PERKITS REOUESTED <br /> <br />Valuation of Total Construction <br /> <br />RI.RCTIlI.CAL <br /> <br />AIIP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />---1IECBAIIICAL <br /> <br />$ <br /> <br />Valuation of tlecbanical Installation <br /> <br />--...PLUtIBIliG <br /> <br />GAS <br /> <br />ROOFIIIG <br /> <br />SPECIALTY . <br /> <br />TYPE OF COISTRUcnOI: ----Block --"r_e _Steel <br /> <br />Other <br /> <br />PDlISHBD FI.OOR. ELEVAnONS: <br /> <br />Fl. <br /> <br />IS PROJECT IIi FLOOD ZONB AREA? <br /> <br />YES NO <br /> <br />.......................................... <br /> <br />RmlJlIm <br /> <br />r:Ci{f' '. ......,' CONTRACTO~. SE5:N .' <br />i ...... ' .. :.;' " . 'mHPAIIY l J,.J ~Ft1L <br />" ~ ! State Cert. or, Regist. . <br />_. ~ - ~ City Liceuse Ilegistration . <br />.......................................... <br /> <br />Signature <br /> <br />4c- () If I AI (/ Y ~, <br />77 <br /> <br />RI.RCTRI.CIAR <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />SignAture <br /> <br />PLutmER <br /> <br />COHPAIIY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />Signature <br /> <br />tlECIIAIIICAL <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration f <br />.......................................... <br /> <br />Signature <br /> <br />OTRRR <br /> <br />COHPANY <br />State Cert. or Regist. . <br />, City License Registration . <br />ft.......................................... <br />'1, <br /> <br />Signature <br /> <br />APPLICAnON APPROVED BY <br /> <br />PERKlT OFFICER. <br />