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<br />APPLICATION FOR PERKIT <br />CITY OF ZEPHYRBILLS <br />BUILDING DEPARTMENT <br /> <br />'7!?F 6 0, '-~v <br />--yt <br />/ D - / -t; <br /> <br />OWNER'S ADDRESS <br /> <br />OWNER'S NAKE jtti-t.E'1' L A)m ~ \(.P\tf. <br />3 g 7 JI <br />l:.. ~~, <br /> <br />~. N~ <br />~ m Oc: rJ -A. \I \i,.J J u:... <br /> <br />PHONUl3 - 780 -70'13 <br />? r;:>t+'1't.\'H <"'W f t.. gU'~o <br /> <br />JOB ADDRESS <br /> <br />S{LV~\t O~\CJ <br /> <br />D -e.\ V i:.... <br />SUBDIVISION ~ ~ ll..V1t t. ~ ~ <br /> <br />LEGAL DESCRIPTION: LOT(S) .2S":2& <br /> <br />BLOCK <br /> <br />PARCEL LD.# 6~ -.2, - 2.C -~\20... t)(JOOO (OBTAIN FROM PROPERTY TAX NOTICE) <br />WORK PROPOSED: ~ew Construction _Addition _Alteration _Repair _Install <br /> <br />_Sign <br /> <br />_Move <br /> <br />_Deaolish <br /> <br />PROPOSED USE: ~ngle Family <br /> <br />_M/F _' of Units _M/H <br /> <br />_C~ercial <br /> <br />_Indust. _Swim. Pool _Other <br /> <br />_Restaurant & Health Department Approval <br /> <br />DESCRIPTION OF WORK: r ($/l. t> <br />BUILDING SIZE: S~ X "]() <br /> <br />2'08)11 <br /> <br />2 (J~ Q... j \N b LA f-AH' ~,.s <br /> <br />~oc:.J C ~w, foo (. <br /> <br />I <br />Square Feet. 2Z Height <br /> <br />RESIDENTIAL : <br />COMMERCIAL <br /> <br />ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br /> <br /> <br />~'lJ'b'(J <br /> <br />PERMITS REOUESTED <br /> <br />~UILDING <br /> <br />~LECTRlCAL <br />~CllANICAL <br /> <br />/;;UMB~NG <br /> <br />W.R.E.C. <br /> <br />Other <br /> <br />/ <br /> <br />IS PROJECT IN FLOOD ZONE AREA? <br /> <br />YES NO <br /> <br />****************************************** <br /> <br />Signature <br /> <br /> <br />CONTRACTOR SECTION <br /> <br />COMPANY AU, 'd fWOU Cv S1"'~ No- W M ti <br />State Cert. or Regist. # t:6l:. (>~,~2- <br />City License Registration , 19z.'Z- <br />. <br />* **************************************** <br /> <br />/' <br /> <br />BUILDER <br /> <br />SiQOAture <br /> <br />COMPANY C OAn", ltV €- i,l.€ C. <br />State Cert. or Regist. t A~es ~l>GfjD <br />City License Registration t .~ ~~ <br />****************************************** <br /> <br />v- <br /> <br />PLUMBER <br /> <br /> <br />COMPANY ge-10<\JG:\ tLVJ"I\.1)\NG l'" G <br />'"State Cert. or Regist. , c.F-c () ~2. 99 B <br />ity License Registration t ~ <br />************************ <br /> <br />/ <br /> <br />Signature <br /> <br />Signature <br /> <br />~ V <br />COMPANY G.;j -Hff/f1'w~"J,. ~le. C.OA)OtT/O"v\,v <br />State Cert. or Regis t. t . C~ 0 c..j-z 99 9 <br />City License Registration . ~~ <br />************~***************************** <br /> <br />MECHANICAL <br /> <br />Signature <br /> <br />COMPANY At,"- fit/'" On.,- LV:>'7'f'- ~ t-i" ( <br />State Cert. or Regist. f c~c O(t?~9Z- <br />~f-\rJ 6 City License Registration # _ /9Z'2- <br />****************************************** <br /> <br />/ <br /> <br />OTQRR <br /> <br />APPLICATION APPROVED BY <br /> <br />PERKIT OFFICER. <br />