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<br />APFl,1(:Atl0N Fon rBI\KIT <br />CITY OF ZSrH1RHILLS <br />&UILDING DEPARTMBNT <br /> <br />~~t q(p' <br />.,jiJ r> ' . <br /> <br />UWNER'S MAHIL..__L.l::!.E.....H,aE..aQ.J~..___...._____.______~_~_PHON.R 'B/3. q'l.J.- '5"56' <br />'"L:) , ...l '2 <br />OWIBR'S AI)I)RM8 f, 0.&" _ t.}.?8. l...,:!E:W (O~f 12"<:-Hf:"i, 1=1 ~yc...;-,. O""':~A <br /> <br />J ' <br /> <br />JOB ADDRBS8,u ,=3C} 1 j I ~ 1'" h A.ve. <br />LBcw.. PlScurnON; wr(s)_~ <br /> <br />l }I'I.' Ii 1 - ~ . <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />PARoeL I.B..... I r~ :.a.<...,.:....2._l:_.,_._ (O~AIN PROM paoPUTY TAX. BOTICR) <br />WORlt PROPOSl1h-LtlftW Cono.t~tioQ ----Addition ~~,^-l,t@t8.ti()n __...Repair _lll8t.ll <br /> <br />_.81811 <br /> <br />_,.--"c.nre <br /> <br />_....DMOliBh <br /> <br />PROPOSED USI: -LJi 10818 F..Uy <br /> <br />_---1I/F .,..i::L..f of Units _--Jt/B <br /> <br />__eo..ecclAl <br /> <br />__lnduelt. .__Swia. Pool _other <br /> <br />~~Reataurant , HCAltJh V@pbrtaent Approvsl <br />DISCRIP'1101 or WUlK:_ . .Seif... AT'AO.q;:T> WJ<:.IT'E.-~ ~ PLAN:) <br /> <br />BUILDING SIZE: <br /> <br />..).. <br /> <br />._____..__..ftquar(! Feet,.. <br /> <br />~.Hei8ht <br /> <br />USIDBIITUJ.: ATTACB (2) PLOT PlANS & (2) 58T5 OF BUILDING PLANS" (1) SBT IIfBRGY PORKS. <br />ootIPIERCIAL: ATTAat (3) SETS OF BUILDING PLANS' (1) SET BNBRGY FORKS. <br />PROP.TV SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />/ BUU.olRG <br />./ KI~C1'R1CAJ.. <br />LJmawnCAL <br />/pt"~RG <br /> <br />llBtW'G JlIQ~U <br /> <br />$___,88,..:iO.:l'':-''~'~A__4Va1UAUon of Total Construction <br /> <br />,"..' t;J. ~p SelVJce <br /> <br />____f lorida Power Corp. <br /> <br />_W.R.B.C. <br /> <br />S..__._~LO,,-O ___Valu.ation of "f!~h(iln1,c.l InataBatioD <br /> <br />__~GAS <br /> <br />__~OOFING <br /> <br />_____SPSClALTY <br /> <br />TYPH OF OOWSTRUcnOM: ~Jloclr. _Fra.e _Steel <br /> <br />Other <br /> <br />'I.UDD FLOOR BLBVATI0NS:_. . ~..". <br /> <br />IS PROJECT IN FLOOD ZONB ARIA' <br /> <br />YIS <br /> <br />- <br />NO <br /> <br />.....*.................................... <br /> <br /> <br />CQITJW.iIQJL..S&,'llOli <br /> <br />CX>tlrAML_Claf?...uc. ,J-! q mE., t\ D~ l,/. R'f LAIt./C-\ J'O <br />~~te Cler.t. or Reel.t., C13 (!o ~~'5"t./q <br />Ulty l.l(:~n8~ Re81stn,t{cm . /<1..3 ~ <br />...~.....................*................ <br /> <br />;lL41 COM.PANY_,__R~E..2:~L.~~~TR I c.. <br />v State Cert. or 1t8g18t..' ~.R. OO'~~:lq <br />, .t1JtN_,.__.._ ___.__ Oity LiceMl! Rl!aistratiou . ~" q <br />, ~............................***..*..... <br /> <br />;.:::a _ <br /> <br />JlJ.JIIID. 'J ~ CotU'ANY_~_-.Cf2I...~'" ~~"I/i.s <br />,:/ StAte Cert. or Reaht. '_&- 0(2 ~ 4'l" ~ <br />SJgoatw:e A-if:!.. l" _ .. .._._.._ City LtcenPilC! Rftglatration . / ~ h <br />*. ..................................... <br /> <br />IIBCIIAIIICAL ~ a OOH.PANY_...'2a~,..Jj[J'II!.N COmEu~T Ewr, <br />St"t.e em:'-- or Realat.' KA ~ ()oqQ ~ <br />8l8nat..re -5- / "I.. -- ~_..__ City Lie..... R.a.8traUon . ~3 <br />~".. ....~,..................tt*.t**..... <br /> <br />onllUI - Kot> F' ~~PlPAHY_ C IA.~,,-~.. d9rn~~ I PEoJ, 8y ~~t'l'.N <br />. State Vert. f)r Rp.8fat.' CeCQ "i ~&J. ~ <br />Slaoature tl; ____ Vlty Lic~.I,l8f! Realstratioll f r'lOJ- <br />......................................... <br /> <br /> <br />APPLICATION APPaOVEh AY _~.._____".".___~___ <br /> <br />PERMIT OprICD. <br />