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<br />APPLICATION FOR PERKIT <br />CITY OF ZEPHYRBILLS <br />BUILDING DEPARTMENT <br /> <br />OWNER'S NAKE <br /> <br />P-tD'" ,'J.o. <br /> <br />Yr'\o .J,,,,,,<:: c:-;. <Q... <br /> <br />PHONE <br /> <br />OWNER t S ADDRESS <br /> <br />JOB ADDRESS <br /> <br />3~ 44- ;;- <br /> <br />cQ. <br /> <br />~<+ EC* <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />PARCEL 1.D.# <br /> <br />2. ~ 2.G,'- 2 \ <br /> <br />(OBTAIN FROM PROPERTY TAX NOTICE) <br /> <br />WORK PROPOSED:~New Construction _Addition ---Alteration _Repair --k:.Install <br /> <br />1.Sign <br /> <br />_Move <br /> <br />_Deaolish <br /> <br />PROPOSED USE: _Single Faaily <br />A~ercial <br /> <br />_KIF <br /> <br />_' of Units _K/H <br /> <br />_Indust. <br /> <br />_Swim. Pool _Other <br /> <br />_Restaurant & Health Departaent Approval <br /> <br />DESCRIPTION OF WORK: Tn::,::> h:. 1 \ <br /> <br />po le <br /> <br />st3'^ <br /> <br />BUILDING SIZE: <br /> <br />x <br /> <br />Square Feet, <br /> <br />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 />PERMITS REOUESTED <br /> <br />-LBUILDING <br /> <br />$ <br /> <br />( 'I DOC:>, c7D <br /> <br />Valuation of Total Construction <br /> <br />_ELEC'I'RlCAL <br /> <br />AMP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />_MECHANICAL <br /> <br />$ <br /> <br />Valuation of Mechanical Installation <br /> <br />_PLUMBING <br /> <br />GAS <br /> <br />ROOFING <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION: _Block _Frtille _Steel <br /> <br />Other <br /> <br />FIRISBED FLOOR ELEVATIONS: <br /> <br />FT. <br /> <br />IS PROJECT IN FLOOD ZONE AREA? <br /> <br />YES NO <br /> <br />****************************************** <br /> <br />CONTRACTOR SECTION <br /> <br />COMPANY <br />State Cert. or Regist. , <br />City License Registration . <br />****************************************** <br /> <br />RIJTlJ)ER <br /> <br />Signature <br /> <br />SifmAture <br /> <br />COMPANY <br />State Cert. or Regist. t <br />City License Registration t <br />****************************************** <br /> <br />ELECTRICIAN <br /> <br />COMPANY <br />State Cert. or Regist. t <br />City License Registration # <br />****************************************** <br /> <br />PLUMBER <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 />Signature <br /> <br />COMPANY ~ 0 V1 b l) '^ '"" "'S i,<J '" <... ~ \... 'lE:o", <br />* n n State Cert. or Regist. f <br />~ vY\ ~)~ -::e:r: City License Registration t I { '2- () <br />****************************************** <br /> <br />OTRRR <br /> <br />APPLICATION APPROVED BY <br /> <br />PERKIT OFFICER. <br />