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<br />APPLICATION FOR PERMIT <br />CITY OF ZEPHYRlIlLLS <br />BUILDING DEPARTMENT <br /> <br />~~. <br /> <br />G /C-A-,v ~ H-o /1-1 ~O IV ..> PHONE 3 S;-8- - ~-;2... 3 -/ 7/( <br />OWNER'S ADDRESS (j) . c!) ....~)(' :t ':l. "f S iJ A- J ~ Cc r;. 3 3 $"'"", <br />7 ~ ~ ~- G;4.~IfNS" Lo~/z" tJ~. <br />LEGAL DESCRIPTION: LOT(S) ~ / <br />, <br /> <br />-:7 '-(' _ 2. ~-- d.-I- c: Ulel ._ C /. '/(j 0 - &;j <br />PARCEL I.D.' ~ ) (OBTAIN FROM PROPERTY TAX NOTICE) <br /> <br />OWNER'S NAME <br /> <br />JOB ADDRESS <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />~~ dr It-o "-I i-D AJ ..S' <br /> <br />WORK PROPOSED:_New Construction _Addition _Alteration _Repair _Install <br /> _Sign _Move _Demolish <br />" <br />PROPOSED USE: _Single Family _M/F _* of Units ~M/H <br /> _Connercial - Indus t. _Swim. Pool _Other <br /> <br />_Restaura. nt & neaHh Depart.ent Approval ~ _ ) <br />DESCRIPTION OF WORK: ?G' r ?,/ cf? /'YJ,#-/ / ~. 0-0 <br />BUILDING SIZE: :J. 7 &, ''-96 Square Feet, Height <br /> <br />RESIDENTIAL: <br />COMMERCIAL : <br /> <br />ATTACH (2) PLOT PLANS Ii (2) SETS OF BUILDING PLANS Ii (1) SET ENERGY FORMS. <br />ATTAal (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PERMITS REOUESTED <br /> <br />_BUILDING <br />LELEC.'TRICAL <br />XMEalANICAL <br />~PLUHBING <br /> <br />$ <br /> <br />Valuation of Total Construction.. <br /> <br />/ S'"/) AMP Service <br /> <br />~~OO <br /> <br />)( Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />$ <br /> <br />Valuation of Mechanical Installation Ale <br /> <br />GAS <br /> <br />ROOFING <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUC.'TION: _Block _FrMle _Steel <br /> <br />Other <br /> <br />YES <br /> <br />-fa- <br /> <br />FINISHED FLOOR ELEVATIONS: <br /> <br />FT. <br /> <br />IS PROJECT IN FLOOD ZONE AREA? <br /> <br />****************************************** <br /> <br />CONTRACTOR SECTION <br /> <br />BUILDIlI\ COIIl'ANY ~ ~ /T .s <br />~ State Cert. or gist.' . . <br />/Signature 6.Jn..., - .(J~ W City License Registration' .y ~ <br />'" ' , <br />, ** ************************************** <br /> <br />ELECTRICIAN COMPANY C ~ 11 o-+JJ-; .e r&7 /o-/d, -IJC. <br />~ / J.. /1 /If) State Cert. or Regist. e- c> 0(;) 00 I <br />SiR.nature CfUi.rU2. JC .~ QW'V City License Registration t / ?7 <br />****************************************** <br /> <br />PLUMBER <br />0ignature <br /> <br />tJ~ <br /> <br />COMPANY ~ ~///.J <br />~ State Cert.--or.- gist. . <br />-LJ .J~ City License Registration , <../ 3' <br />*** ************************************* <br /> <br />Signature <br /> <br />COMPANY C 1 e " ,- <br />It/) r,/? State Cert. or Regist. <br />C~A, (fJ..e.-&~ City License Registration' <br />****************************************** <br /> <br /> <br />MECHANICAL <br /> <br />OTHER <br /> <br />COMPANY <br />State Cert. or Regist. t <br />City License Registration t <br />****************************************** <br /> <br />Signature <br /> <br />APPLICATION APPROVED BY <br /> <br />PERMIT OFFICER. <br />