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<br />APPLXCATXON FOR PERKI.T <br />CXTY OF ZEPIIYlUIll.LS <br />BUILDXNG DEPARTKEHT <br /> <br />JOB ADDRESS <br /> <br />::tD tr\ tJ H lit f r <br />~P// /6.z:t1 sr. <br />s/1fYJ~ <br /> <br />PHONE <br /> <br />7rd~//to <br /> <br />OWNER' S HAHE <br /> <br />OWNER' S ADDRESS <br /> <br />LEGAL DESCIUP'llON: LOT(S) <br /> <br />BLOCK <br /> <br />SUBDXVISXON " <br /> <br />PARCEL X.D.' (OBTAXN FROM PROPERTY TAX NOTXCE) <br />~ V <br />WORK PROPOSED:--=--Xew Construction ---Addition --.Alteration --Repair _I.nstall <br /> <br />_Sign <br /> <br />---1Iove <br /> <br />_Deaolish <br /> <br />P~POSEDUSE: ~~eF_i~ <br /> <br />---1I/F _' of Units ---1I/H <br /> <br />_~rcial <br /> <br />_Indust. _Swia. Pool _Other <br /> <br />--Restaurant &: Hea1th Departaent Approval <br />DESCIUP'fiON OF WORK: fEfYJtJllaJJJ&- I~ " tJr I9SfJHJ/lf d-. /'fA.ALL Jr f/LJ/rH <br />1St> <br />. <br /> <br />CtJtJc~ J-~~J' <br /> <br />BUILD:IHG SUE: <br /> <br />x <br /> <br />Square Feet. <br /> <br />Height <br /> <br />RESIDENTIAL: ATTACH (2) PLOT I'LANS II (2) SETS OF BUlLDXNG PLANS II (1) SET ENERGY FORMS. <br />COMMERCIAL: ATTACH (3) SETS OF BUILD:IHG PLANS &: (1) SET ENERGY FORMS. <br />P~PERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PERMITS REOUESTED <br /> <br />V'BUILD:IHG <br /> <br />$ <br /> <br />floolPt> <br /> <br />Valuation of Total Construction <br /> <br />_ELEcrIUCAL <br /> <br />AIIP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />----.JIECllAlUCAL <br /> <br />$ <br /> <br />Valuation of Mechanical Xnstallation <br /> <br />_PLUKBUIG GAS ROOFXNG <br /> <br />SPECIALTY . <br /> <br />TYPE OF COIISTRUcnON: _B1ock _FraIIe _Steel <br /> <br />Other <br /> <br />FD1I.SBED FLOOR ELEVAnONS: <br /> <br />FT. <br /> <br />XS PROJEct I.N FLOOD ZONE AREA'l <br /> <br />YES NO <br /> <br />.......................................... <br /> <br />Signature <br /> <br />CONTRActOR SECTION <br /> <br />~~.. "aiKPANY /JL:,'e /JLMY/. <br /> <br />"..'" State Cert. or Regist.' ClCco..1 '1b~t) <br />__________ City License Registration , JP~ <br />......................................*... <br /> <br />BUILDER <br /> <br />PoT .F.CTRICIAII <br /> <br />COMPANY <br />State Cert. or Regist. , <br />City License Registration , <br />.......................................... <br /> <br />Sianature <br /> <br />COMPANY <br />State Cert. or Regist. , <br />City License Registration f <br />.......................................... <br /> <br />PLUKBER <br /> <br />Signature <br /> <br />COMPANY <br />State Cert. or Regist. f <br />City License Registration . <br />.......................................... <br /> <br />MECHANICAL <br /> <br />Signature <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration , <br />.......................................... <br /> <br />OTHER <br /> <br />Signature <br /> <br />APPLICATXON APPROVED BY <br /> <br />PERHIT OFFICER. <br />