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<br />APPLICATION FOR PERMIT <br />CITY OF ZEPIIYRIIIUS <br />BUILDING DEPARTKERT <br /> <br />OWNER' S ADDRESS <br /> <br />~, <br />.j~#~ ? <br />30''1- )7 <br /> <br />~ 4. (J. PHONE ?r;Z U'"'?,;?? <br />~C., ~~/, <br />~C~ <br /> <br />OWNER' S RAHK <br /> <br />JOB ADDRESS <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCIL--SUBDIVISION <br />(OBTAIN FROK PROPERTY TAX NOTICE) <br /> <br />PARCEL LD.' <br /> <br />WORK PROPOSED:.-Rew Construction ----Addition ----1a1teration ..-Jlepair .,LInstall <br /> <br />_Sign <br /> <br />----1k>ve <br /> <br />_Deaolish <br /> <br />PROPOSED USE: _Single Faaily <br />_~.J:~ercial <br /> <br />--Yt/F _' of Units ->l/H <br /> <br />_Indust. _Swia. Pool _Other <br /> <br />..-Jlestaurant &: Health Departa~t Approval ~ ~ I <br />DESCRIP'fiOll OF 1iOIlK: ,~ /0' ~ 1./" /- w,d;t' ~ a...-;, <br /> <br />BUILDING SIZE: X Square Feet, Height <br /> <br />RESIDERTIAL: <br />COMMERCIAL : <br /> <br />ATrACH (2) PLOT PLANS &: (2) SETS OF BUILDING PLANS &: (1) SET ENERGY FORMS. <br />ATTACH (3) SETS OF BUILDING PLANS &: (1) SET ERERGY FORMS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PERMITS REOUESTED <br /> <br />~UILDING <br /> <br />$ <br /> <br />Valuation of Total Construction <br /> <br />_ELECTRICAL <br />k..JmCBAllICAL <br /> <br />AIIP Service Florida Power Corp. <br />$ ;) 9 a () J;.b. Valuation of Kecbanical Installation <br /> <br />W.R.E.C. <br /> <br />_PLUKBING GAS ROOPIRG <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTR.UcnON: _Block _Fraae _Steel <br /> <br />Other <br /> <br />FIllISHED FtOOR ELEVAnONS: <br /> <br />Fr. <br /> <br />IS PROJECT IN FtOOD 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 />RIJTI.DER. <br /> <br />Signature <br /> <br />SiDnAture <br /> <br />COMPARY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />RT .R.CTRTCIAII <br /> <br />COKPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />cmlPAIIY 1"-7J~ ~ · <br />State Cert. Regis t. . 0 .j3..J9..:r"" <br />City License Registration' '/iF- -' ..2 ? <br />.......................................... <br /> <br />PLOIIBER <br /> <br />Signature <br /> <br />KECBAlIICAL <br />k Signature <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />flTIIR.R <br /> <br />Signature <br /> <br />APPLICAnON APPROVED BY <br /> <br />PERMIT OFFICER. <br />