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<br />APPLICATION FOR PERKIT <br />CITY OF ZEPIIYRBILLS <br />BUILDING DEPARTKENT <br /> <br />OWNER'S NAHE <br /> <br />S IJ/YJ '-$ G{)- <br /> <br />OWNER'S ADDRESS Lt)T-3~ .d'J'()1J9" 1.. ,lJW/f)/LJA AtJOJO <br />JOB ADDRESS Si9I'J.E <br /> <br />PHONE <br /> <br />7[>3 ?'btJJ''l <br /> <br />LEGAL DESCRIPTION: LOT(S) BLOCK...--SUBDIVISION <br />PARCEL LD.' /1/-;2t -;).j- ~/6tJ-.o~- t?J~LJ (OBTAIN FROM PROPERTY TAX NOTICE) <br />WORK PROPOSED: ~ew Construction ----Addition ---..Alteration __epair _Install <br /> <br />_Sign <br /> <br />--1fove <br /> <br />_Deaolish <br /> <br />~ <br />PROPOSED USE: ___S~eF_ily <br /> <br />--1!f./F _' of Units --1!f./B <br /> <br />___ec-ercial <br /> <br />_Indust. ___Swia. Pool _Other <br /> <br />__estaurant Ii Health Departaent Approval <br /> <br />DESCRIPTIOR OF WORK: Ct/vc'~LrE '- ..5'H$f) - c.:/1~/"O/L.,--r- <br />rorA c..- <br />BUILDING SIZE: /..2xYx /2 . ~...?~ Square Feet, 9 n'j~~ight <br /> <br />RESIDENTIAL: ATTACH (2) PLOT PLANS Ii (2) SETS OF BUILDING PLANS Ii (1) SET ENERGY FORMS. <br />COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS Ii (1) SET ERERGY FORKS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PERMITS REOUESTED <br /> <br />V <br />~UILDING <br /> <br />$ <br /> <br />~Dt).oo <br /> <br />Valuation of Total Construction <br /> <br />___ELECTRICAL <br /> <br />AIIP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />-lIECBAIIICAL <br /> <br />$ <br /> <br />Valuation of Mechanical Installation <br /> <br />___PLUKBIRG GAS ROOFING <br /> <br />SPECIALTY ' <br /> <br />TYPE OF CORSTRUcnON: ___Block ___Fraae ___Steel <br /> <br />Other <br /> <br />FIllISHBD FlOOR ELEVATIORS: <br /> <br />Fl. <br /> <br />IS PROJECT IR FLOOD ZOO AREA? <br /> <br />YES NO <br /> <br />.......................................... <br /> <br />Signature <br /> <br />CONTRACTOR SECTION <br /> <br />~ ,," .. cdttPARY /TL:.E-/TLtI.&I. <br /> <br />'l' ~/J State Cert. or Resist. t CRe"'3</6J"D <br />~ ~ City License Registration . ;.r~ <br />, .......................................... <br /> <br />BIITlDER <br /> <br />RT.RCTRICIAR <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />SianAture <br /> <br />PLUKBER <br /> <br />Signature <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />MECHANICAL <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />Signature <br /> <br />OTRRR COMPANY <br />State Cert. or Regist. . <br />Signature City License Registration . <br />.......................................... <br /> <br />APPLICATIOB Al'PIllIVBlI BY ~ ~M~'\I::::., PI!RIIlT OFFICER. <br />