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<br />AFPLIcAtlON FoR rRRHIT <br />CIIY or ZErHiRM1Ll~ <br />butLDING DEPARTMBNT <br /> <br />;J~:< <br />. '!ILl ----;;;:zPHONP. )4w'''''5 6 ;? - ':>/ If ::. <br /> <br />OWNU'S N <br /> <br /> <br />LlGAL PISClll'Tloth LOT(S) BI.OCIL-..SUBDIVlSION <br />PAROEL I.D.' )a,~.;2f,' ~ L- 0).~.D - O~ "' q 8~ 0 (OBTAIN PROM PIDPItRTY TAX. tlO,.IClU <br />WORK PROPOSlDs_"ev Coftat.ru.ctioQ -----Addition _J.1teration __Jepair _Install <br /> <br />JOB ADDU88 <br /> <br />_Si8Q, <br /> <br />_---"'aye <br /> <br />--.J}MOlish <br /> <br />PROPOSED USB: ~ioale F..Uy <br /> <br />_J/F ..__f of Units ---1I/B <br /> <br />__ec-ecclal <br /> <br />__IodUl!lt. _Swt.. Pool _other <br /> <br />~e.taurant , Health Dep8rtaent Approval <br /> <br />DBSCIUPTIOI 0' MOM; <br /> <br />BUILDING SIZI: <br /> <br />.x... <br /> <br />.__,_Jquare Peet, <br /> <br />.Height <br /> <br />USJDDTIAL: AtTACH (2) PLOT PLANS, (2) SETS OF BUILDING PLANS" (1) SBT BNERG! FORMS. <br />cotIKBRClAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET 2NBRGY FORMS. <br />PROpaTV SURVEY RBQUlRBD FOR ALL NEW CONSTRUCTION. <br /> <br />p~U'G REOUE5'l1W <br /> <br />___UlLDlNO <br /> <br />$-~............ <br /> <br />_~___Va1ualion of Total Construction <br /> <br />KI.Ect'I1CAL <br />--1lECllAllI.CAL <br />-PLtItIIRG <br /> <br />-fl.P Service <br /> <br />__Florida Power Corp. <br /> <br />M.R.B.C. <br /> <br />S......",_.UIff_"'_' ".1/_ <br /> <br />. . ..__valuation of Mp.ch8ni,clll Jmatal.lation <br /> <br />~GAS <br /> <br />_---ROOFING <br /> <br />SPBClALTY <br /> <br />typE 0' OOlIS'D.UcnOlh __Jloclt _Fraae _Steel <br /> <br />.......Other <br /> <br />nlURID FLOOR BLBVAtlOJlS:__ <br /> <br />FT. <br /> <br />IS PROJECT IN FLOOD ZONB ARIA' <br /> <br />TIS NO <br /> <br />.......................................... <br /> <br />CORTRA~Q.SECTION <br /> <br />IIRLDa ootlPAMyJ.f~o.~ '-fJ.~ ~ av.. <br />tAlte Cert, or Re8lat. , Q.. 'Bc..o ~ <br />Signature Oity Llc~8e R@gistr.tlon . <br /> <br /> <br />= ~2l""'''''''.''''.;:::::g:;;~~~. <br /> <br />, . State Cert. or ReBlet. ..Ji&.Cla ';"Zi <br />__ e _,__.____,_ .____ City License Re8istratiol'l . _ & _ <br />.......................................... <br /> <br /> <br /> <br />Signature <br /> <br /> <br />CotlPANY_ Q.. <br />StAte Cert. or 8 t.' <br />City Ltcen5~ R~gi.tration . <br />............................... <br /> <br /> <br />PUJDD. <br /> <br />Signature <br /> <br />KKCIIAIIICAL <br /> <br />OOKPANY <br />State Ccrt. or Reeist. <br />City License Reaistration . <br />..................................**...... <br /> <br /> <br />~. <br /> <br />11111II <br /> <br />Sianatu.re <br /> <br />COMPABY ~_ <br />State Cect. or RP.st.t. . <br />City LiCen8e Registration . <br />.......................................... <br /> <br />APPLICATION APnf)V1U) BY ._~_._, .. ,..____... <br /> <br />P2RM1T OPFICER. <br />