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<br />APPLICATION FOR PERMIT <br />CITY OF ZEPHYRBILLS <br />BUILDING DEPARTMENT <br /> <br />g'3 L{ <br />9KO'l a_'f'1 <br />~/ ~{ <br /> <br />JOB ADDRESS <br /> <br />f<'.-r ~ ~ <br />4--'( I '3, ~ I )..., VE12 <br />14 s )4 Eo v E <br /> <br />PHONE ~ g 0 - "3 (;, '7 L <br />"z.6P HY iZH-ILLs fL s.s~4-( <br /> <br />OWNER'S NAKE <br /> <br />OWNER'S ADDRESS <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />BLOCK <br /> <br />SUBDIVISION..bH...tl L Fa N T V j LL ~ <br /> <br />PARCEL 1. D.' <br /> <br />(OBTAIN FROM PROPERTY TAX NOTICE) <br /> <br />WORK PROPOSED:_New Construction VAddition ~teration ~epair _Install <br /> <br />_Sign <br /> <br />.-Jove <br /> <br />_Deaolish <br /> <br />PROPOSED USE: _Single Faaily <br /> <br />_M/F _' of Units ---1l/H <br /> <br />_~ercial <br /> <br />_Indust. _Swia. Pool _Other <br /> <br />_Restaurant,. Health Departaent Approval <br /> <br />DESCRIPTION OF WORK: ..s eRE"' E ,,( n. b 0 M <br /> <br />BUILDING SIZE: 0 X 2l, \ b ~ Square Feet. ~ I Height <br /> <br />RESlDENTIAL: ATTACH (2) PLOT PLANS,. (2) SETS OF BUILDING PLANS,. (1) SET ENERGY FORMS. <br />COttHERCIAL: ATTACH (3) SETS OF BUILDING PLANS &: (1) SET ENERGY FORMS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PERMITS REOUESTED <br /> <br />L.sUILDING <br /> <br />$ <br /> <br />500 <br /> <br />Valuation of Total Construction <br /> <br />_ELECTRICAL <br /> <br />AMP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />.-JIECIIAIIlCAL <br /> <br />$ <br /> <br />Valuation of Mechanical Installation <br /> <br />_PLUMBING GAS ROOFING <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUC'l'lON: _Block _Fraae _Steel <br /> <br />Other <br /> <br />FlRISHED FLOOR ELEVATIONS: <br /> <br />FT. <br /> <br />IS PROJECT IN FLOOD ZONE AREA? <br /> <br />YES NO <br /> <br />****************************************** <br /> <br />Signature <br /> <br />CONTRACTOR SECTION <br /> <br />~ COMPANY 9.U.5SELL Y\'\ ~110Lu~ <br />State Cert. or Regist.' CO:: 0 31 b / <br />/ , rv1, 'M\IfJt,vv.... City License Registration' 243 <br />****************************************** <br /> <br />RIJTT .DER <br /> <br />SionAture <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration . <br />****************************************** <br /> <br />F.T.RCTRICIAH <br /> <br />COMPANY <br />State Cert. or Regist. . <br />City License Registration f <br />****************************************** <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />COMPANY <br />State Cert. or Regist. . <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 />OTRRR <br /> <br />Signature <br /> <br />APPLICATION APPROVED BY <br /> <br />PERMIT OFFICER. <br />