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<br />APPLICAnON FOR PEBKlT <br />CITY OF ZEPIIYlUIILLS <br />BUlLDIRG DEPART!lEHT <br /> <br />OWNER'S IWIE .(Qt......#fl.gSriM/ (e-y ;Iv P;-/JL. o.skr' <br />33002" I-I+W1+.N~i ~t3 p <br />, <br /> <br />;fJ J?taJ ~l IE <br />LEGAL DESCRIPTION: I.OT(S) / i BLOCK d (, SUBDIVISION c2. / <br />PARCEL I.D.' ~ /~O - 00000 - 0 I 9 () (OBTAIN FROM PROPERTY TAX NOTICE) <br />WORK PROPOSED:~ew Construction ~ition --Alteration --....Jtepair _Install <br /> <br />OWER'S ADDRESS <br /> <br />PHONE ;; r~ - ~/ / () <br />.2-~~/I,,1Lr <br /> <br />JOB ADDRESS <br /> <br />_Sign <br /> <br />--.JIove <br /> <br />---Peaolish <br /> <br />PROPOSED USE: Lsingle Faally <br /> <br />---1:t/F _' of Units ---1:t/H <br /> <br />_ec:-ercial <br /> <br />_Indust. _Swia. Pool _Other <br /> <br />Restaurant Ii: Health Departaent Approval <br /> <br />DESCRIPTIOII OF WOl\,K: ~,J? ,/ i:r #aA e ?A-c.K 1'9-r~ <br />I f('f ~ F'f; oS HtFb -/ CJ:J. pr Sc...t.1f'c#,2,o~ - ~6 :y,t::-f" C!..~p, Itr <br />BUlLDIRG SIZE: X, Square Feet, Height <br /> <br />RESIDEIITIAL: ATTACH (2) PLOT PLAIIS Ii: (2) SETS OF BUlLDIRG PLANS &: (1) SET ENERGY FORMS. <br />COHHERCIAL: "TrACII (3) SETS OF BUILDIRG PLANS Ii: (1) SET ENERGY FORKS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PERMITS REOUESTED <br /> <br />V;UlLDIRG <br /> <br />$. /OJ 000 00 <br /> <br />Valuation of Total Construction <br /> <br />RT.J;:CTlUCAL <br /> <br />AKP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />----lfECIWIlCAL <br />--YLUMBIRG <br /> <br />$. <br /> <br />Valuation of Mechanical Installation <br /> <br />GAS ROOFING <br />Block ~aae -5teel <br /> <br />SPECIALTY . <br /> <br />TYPE OF COIISTB.UcnOB: <br /> <br />. <br /> <br />4h.J.M~/"IJ.H Other <br /> <br />PIRlSBED FLOOR ELEVAnOIlS: <br /> <br />Fl. <br /> <br />IS PROJECT IN FLOOD ZONE AREA? <br /> <br />~ <br /> <br />.......................................... <br /> <br />YES NO <br /> <br />Signature <br /> <br /> <br />CONTRACTOR SECTION <br /> <br />. ~Ml'Lt{EAlvi/~N.s;'ff't.r~~~7~ <br />State Cert. or R gist. . 1"\ S' . <br />City License Registration f .3.S~ ....3..5''7-3.S' y <br />....................................... <br /> <br />" <br /> <br />BlJTT.DER <br /> <br />,'. <br /> <br />RT .RCTRICIAII <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />Sianature <br /> <br />PLUMBER <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />Signature <br /> <br />HECHAHICAL <br /> <br />COHPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />Signature <br /> <br />O~ <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration , <br />......................................~... <br /> <br />Sigoature <br /> <br />APPLICATIOII APPROVED BY <br /> <br />PERKIT OFFICER. <br />