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<br />APPLICATION FOR PERKlT <br />CITY OF ZEPBYRHILLS <br />BUILDING DEPARTHENT <br /> <br />OWNER'S RAHE <br /> <br />j-f ~ ~~ <br />~ / 7.. ?j~Ja;J <br /> <br />PHONE <br /> <br />7 ? Y- ~ '1 Lj , <br /> <br />, <br /> <br />OWNER'S ADDBESS <br />JOB ADDRESS J Go. J'M e <br /> <br />Sr <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />OG-,cs- j'd~ <br /> <br />PARCEL 1.D.# <br /> <br />(OBTAIN FROM PROPERTY TAX NOTICE) <br /> <br />WORK PROPOSED :~ew Construction --...Addition --Alteration -...Repair _Install <br /> <br />_Sign <br /> <br />---..JIove <br /> <br />_Deaolish <br /> <br />PROPOSED USE: _Single Faaily <br /> <br />---..JI/F _' of Units ---..JI/H <br /> <br />_<=<-ercial <br /> <br />_Indust. _Swia. Pool _Other <br /> <br />-...Restaurant & Health Departaent Approval <br /> <br />DESCRIPTION OF WORK: <br />BUILDING SIZE: Z '-I <br /> <br />l<iL re-J <br />Xr'J (" f ,/2 Square Feet, ~ Height <br /> <br />InIN- <br />, <br /> <br />RESIDERTlAL: <br />COItKERCIAL : <br /> <br />ATtACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />ATlACII (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PERKITS REOUESTED <br /> <br />~UILDIliG <br /> <br />$ lyo.;) <br /> <br />Valuation of Total Construction <br /> <br />RT.RCI'RICAL <br /> <br />AIIP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />---lIEClWlICAL <br /> <br />$ <br /> <br />Valuation of Mechanical Installation <br /> <br />-PLUHBIliG <br /> <br />GAS <br /> <br />ROOFING <br /> <br />SPECIALTY <br /> <br />TYPE ~F: mllsTRucnoR: -Block _Fraae _Steel <br /> <br />Other <br /> <br />FIllISHBD FLOOR ELBVAnOIlS: <br /> <br />FT. <br /> <br />IS PROJECT IN FLOOD ZONE AREA' <br /> <br />.......................................... <br /> <br />YES NO <br /> <br />RMIllRR /l <br /> <br />Signatur' ~ <br /> <br /> <br />CONTRACTOR SECTIQN <br /> <br />COIIPAIIY (!d. v~ t!J..M. it: T ~ 'i , <br />State Cert. or Regist.' C ~ 0.3.; ? 7 <br />City License Registration . .L .2b"3 <br />.................................. <br /> <br />RT .RCTRICIAI!I <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />SiOOAture <br /> <br />PLmmER <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />Signature <br /> <br />IlECllANIGAL <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration f <br />.......................................... <br /> <br />Signature <br /> <br />OTRRR <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />Signature <br /> <br />APPLlCATIOR APPROVED BY <br /> <br />PERKlT OFFICER. <br />