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<br />f?l,-DC4: f( ~I{ '* &/1./&1 <br /> <br />APPLICArIOIII FOR PERltIT <br />CITY OF :l.II:I."J:IIKH. ..Le;; <br />BUII.DI.IIG J)EPAll'IIIEln' <br /> <br />fUt'DA M{vlfAf/ Wft <br />7~ 1~ 1~q(P <br /> <br />OWNER'S HAHEfiortlP)( M{DI~ WNl6 <br /> <br />OWNER'S ADDRESS~ M~1 ~1. terl1f9J1,UbJ <br />I ' <br />JOB ADDRESS ,0'oq ~~. <br /> <br />PBO~?//,Z,I/I?~l <br />kk. <br /> <br />LEGAL D~CRIPl'ION: wr(s) <br /> <br />B.LOClC <br /> <br />SUBDIVISIOJ!J <br /> <br />PARCEL 1. D. t <br />WORK PROPOSED:_lIev Construction ~tion / A1teration _Repair <br /> <br />Install, <br />- ",,^ <br /> <br />_Sign <br /> <br />-----.JIove <br /> <br />_DeIIolish <br /> <br />_~rcia1 <br /> <br />_Indust. <br /> <br />_S.o.. Pool <br /> <br />, ---3f./H. <br />~ther.' <br /> <br />PROPOSED USE: Single Faail.y <br /> <br />---1J/F <br /> <br />_' of Units <br /> <br />_Rest:aurant &: Bea1t:h Depart:llent Approva1 <br /> <br />Square Feet, <br /> <br />Height <br /> <br />BUILDIHG SIZE: <br /> <br />x <br /> <br />RESIDEHTIAL : <br />cott!IERCIAL : <br /> <br />A'l'TAGH (2) PLOI' PIARS &: (2) SETS OF B1JIIJ)IJiG PLAKS &: (1) SET EllERGY FORKS..** <br />ATIACH (3) SETS OF B1JIIJ)DG PLUS &: (1) SET ENERGY FORKS.** <br />**COPr OF CONTRAcr REQIJIRED. <br /> <br />PRRKT"I"S REQUESTED <br /> <br />_BUTI.DING <br /> <br />$ <br /> <br />Va1uatiOll of Tota1 Construction <br /> <br />_ELECTRICAL <br />~CAL <br /> <br />AKP Service <br /> <br />Florida Power Cbrp. <br /> <br />W.R.E.C. <br /> <br />$,. <br /> <br />31QOiOO <br /> <br />Va1uatiOll of Hechanica1 Installation <br /> <br />---..PLUKBIHG <br /> <br />GAS <br /> <br />KOOFIHG <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION: _Block _Pralle _Steel <br /> <br />.. <br /> <br />Other <br /> <br />FDIISBED FLOOR KLEVAnOHS: <br /> <br />FI'. <br /> <br />IS P.RO.JECT IIi FLOOD WIlE AREA? <br /> <br />YES NO <br /> <br />****************************************** <br /> <br />COJI'I'RACIOR SECTION <br /> <br />BUU.DEIl <br /> <br />Signature <br /> <br />COItPAIUY <br />State Cert. or Regist. # <br />City License Registration I <br />****************************************** <br /> <br />ELEGTRICIAH <br /> <br />CO!IPABY <br />St:at:e Cert. or Regist. , <br />. City.I..i.cense RegiSf:T.at"i.<<m t <br />****************************************** <br /> <br />Sil!'O::t:hrre <br /> <br />PLUttBER <br /> <br />Signature <br /> <br />CO!IPAIiY <br />St:at:e Cert. or Regist. , <br />City License Registration I <br />****************************************** <br /> <br />KECUAliICAL <br /> <br />Signature <br /> <br />CO!IPABY <br />State Cert. or Regist. I <br />City License Registration t <br />***********~****************************** <br /> <br />0'I'1IRR <br /> <br /> <br />OY~~ 0U 0ff4N/L~~, (NG, <br />S~te ~rt:. or R~gist..' mgCfJO~~t17 <br />C1t:y L1cense Reg1strat1on , <br />************************************** <br /> <br />~ <br /> <br />Signature <br /> <br />APPLICAnON APPROVED BY <br /> <br />PERKIT OFFICER. <br />