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<br />APPI.TCATIO~ FOR PEmllY <br />CITY OF ZE:PHYllliILLS <br />BUU.DUiG ~JiJ:PAR:lHE',NJT <br /> <br />OkWER · S NAH.E <br /> <br />PHONE: <br /> <br />OWNER · S ADDRESS <br /> <br />JOB ADDRESS <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCK <br /> <br />SlJJBDH"ISION <br /> <br />PARCEL I. D. # <br /> <br />WORK PROPOSED:_New Construction _Addition _Alteration _Repair _Install <br /> <br />_Sign <br /> <br />_Hove <br /> <br />_Deaolish <br /> <br />PROPOSED USE: <br /> <br />Single Faail}~ <br /> <br />_KIF <br /> <br />_, of Units <br /> <br />_M/H <br /> <br />_CoBaercial <br /> <br />_Indust. <br /> <br />_SW1... Pool <br /> <br />Other <br /> <br />_Restaurant & Healt:h Departaent Appro\Yal <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />Square Feet. <br /> <br />He ight <br /> <br />RESIDENTIAL: <br />COHKERCIAL : <br /> <br />ATI'ACH (2) PLor PLANS & (2) SETS OF BUILDING PIJ'UlJS & (1) SET EJi/ERGY FORMS. ** <br />ATTACH (3) SETS OF BUIIDllIG PLAJNrS & (1) SET ElNlERGY FORMS. U <br />**COPY OF CONlTRACT RE'QIJJ1lRED. <br /> <br />PERKITS RE.QUR.'iTED <br /> <br />_BUILDING <br /> <br />$ <br /> <br />VaIuation of Total Construction <br /> <br />_ELECTRICAL <br /> <br />AKP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />_MECHANICAL <br /> <br />s <br /> <br />VaIuation of Hechanical Installation <br /> <br />_PLUMBING <br /> <br />GAS <br /> <br />RooFIlNlG <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION: _Block _Fraae _Steel <br /> <br />Other <br /> <br />FIlIfiSHED FLOOR ELEVATIOlNlS: <br /> <br />FT. <br /> <br />IS PROJECT IN FLOOD ZONE AREA? <br /> <br />YES NO <br /> <br />BUILDEffi <br /> <br /> <br />****************~******************* <br /> <br />roMRACTOR SECTION <br /> <br />COMPMIIY IV. 8. J-4YE S ..J/l./C <br />State Cert. or Regist.~ 1# CGCO st(9/t) <br />~ City License Registration 4# /6t,;:L <br />********************************** <br /> <br />K Signature <br /> <br />( Simtature <br /> <br />ELECTRICIAN <br /> <br />/kJf ~ <br /> <br />/' <br />/ <br /> <br />/ aMlPANY H. ;J. ff-'f Y E5., Me <br />~ State Cert. or Regist. 4# E,(f ()oo (?-I S7) <br />/ . -~4 City License Registration" / t, ~ V <br />********"********************************* ' <br /> <br />Signature <br /> <br /> <br />~~+*+++++*++~**++++**************** <br /> <br />CO!tPAn rNI);,=;O,;wpb1/r //"'ul1,:J,#6 0,= FL. -hvC <br />St:,at:e Cert. or Regist:. '4# CF(-O,;U~$~~ <br />Cit.y License Registrat.ion iIF / t' ~ / <br />. <br /> <br />PLUMBER <br /> <br />KE,C'HAlIfi GAL <br /> <br />COUP~..NY IV, IJ, If;t- y ~ S JA/l'". <br />St:ate Cert. or Regist: '4# ("A-('O 'I/-."/S 7 <br />Cit-y License Registrat:ion I /6 b 3 <br />*******~*~****~******************* <br /> <br />( Signature <br /> <br />OTHER <br /> <br />OOHPMIY E 1.//tfI/5 G /\I -rn /t"C" T7 oN 6 <br />7/ / / ~ State Cert. or Regist. #I: C ceo 16 <:) r?-t <br />~ ~--------- City License Regist:ration #I: / b t:. ~- <br />~ ****************************************** <br /> <br />Signature <br /> <br />APPLICATION APPROVED BY <br /> <br />PERMIT OFFICER. <br />