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<br />\.JH I Ur Zr;PHYRHILLS <br />BUILDING DEPARTMENT <br /> <br />~ ,:S' ~y'1,4 '1 !~ <br />PHONE f'J ~ 3,9 'LDZ-,;t <br /> <br />...:.:~. <br /> <br />OWNER'S N~,n'\U~oN <br />OWNER'S ADDRESS ~ ~ 5 3 ~ <br />JOB ADDRESS ~ ~ <br />LEGAL DESCRIPTION: LOT(S) \ <+0 BWCK <br />PARCEL 1.0.# 3:; - ~ S -d \ - 665ft- 060Qb <br />WORK PROPOSED:____New Construction ~ddition <br /> <br />-\.:brL \-0 r..) <br />la.e.~\(S f\-uc, <br /> <br />::tJ~ <br /> <br />'.{'i <br /> <br />",~r;,,' <br /> <br />SUBDIVISION GJ~ ~ (j &f) ~ y ';':~:~. <br />, ""WI'I'" <br />- 1400 (OBTAIN FROM PROPERTY TAX N()~t~E) <br />"!~. <br />-Alteration -Repair _Ins#Ul <br />""l,~4~>' <br /> <br />_Demolish <br /> <br />PROPOSED USE: <br /> <br />____Sign <br /> <br />~le <br /> <br />-Hove <br /> <br />Family <br /> <br />____M/F <br /> <br />_' of Units <br /> <br />_M/H <br /> <br />. <br />. .....~ <br /> <br />_Commercial <br /> <br />_Indust. <br /> <br />_Swim. Pool <br /> <br />_Other <br /> <br />t""? <br />, . :~.." <br />. ',:~' <br />~t <br />f <br /> <br />;.-l'_' <br />i.';:l~" <br />~:';(~~t <br /> <br />~estaurant & Health Department Approval <br />DESCRIPTION OF WORK: - ~ M"'- ~ <br /> <br />BUILDING SIZE: \ L <br /> <br />x..-ll,p , <br /> <br />1<17- <br /> <br />Square Feet, )r I Height <br /> <br />RESIDENTIAL: <br />COMMERCIAL : <br /> <br />..0~{t ", <br />ATTACH (2) PLOT PLANs & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORM$l;l <br />ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.~~{~ <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. ,'{ti" <br />", '.~(( <br />'Xii <br />;;,~ ' <br />. ! ~ .\:'~' <br /> <br />PERMTTS REOUESTE~ <br /> <br />~NG <br /> <br />~CTRIGAL <br /> <br />$ <br /> <br />\6,00 0 <br />I <br /> <br />Valuation of Total Construction <br /> <br />____PLUMBING GAS <br />TYPE OF CONSTRUCTION: ~k <br />FINISHED FLOOR ELEVATIONS: <;y~' FT. <br /> <br />,~:~ ' <br />~W.R.E.C';~,r <br />,~$~~:: <br />Val:::N:f Mechanical ::::iOO1;1:,',,'" <br />,i~'t~' <br />~~<t.. <br /> <br />Florida Power Corp. <br /> <br />AMP Service <br /> <br />_MECHANICAL <br /> <br />$ <br /> <br />_Fra..e <br /> <br />_Steel <br /> <br />Other <br /> <br />IS PROJECT IN FLOOD ZONE AREA? <br /> <br /> <br />YES NO <br /> <br />.....***.*****..************************** <br /> <br />CONTRACTOR SECTION <br /> <br />BUILD~~< COMPANY R M~ Gnvsd- <br />. State Cert. or Regist. #CRc -03 <br />Signature '--- ~ City License Registration # 9-~ 4- <br />***.*..*.******************************** <br /> <br />;{. <br />:':j.:... <br />i/..... <br /> <br />ELECTRICIAN ...-----~, COMPANY M A-rL~ N );: [e.ch '{ c. <br />~ " ')L~" State Cert. or Regist. # e:~ 'bo\~4-<>A <br />Silwatur tf'.-.c- C8L . - (~ / City License Registration # D-<-r t <br />***..*****..****************.************* <br /> <br />':.,l, <br /> <br />:.''tfl. <br />~~i,,?.'-: <br /> <br />Signature <br /> <br />0J p,- <br /> <br />I <br /> <br />COMPANY <br />State Cert. or Regist. # <br />City License Registration , <br />.****************************.************ <br /> <br /> <br />PLUMB~ <br /> <br />ME CHANI CA'(" <br /> <br />d7 0 COHPANY t. 's Lo v < c.. <br />j. ~~1_ -= 6':/ State Cert. or Regist. # CA~O S <br />/ <----- City License Registration , <br />~**************************************.~ ' <br /> <br />Signature <br /> <br />o~ ~ COHPANY~ ~ e.oo.k~ ~L; <br /> <br />, ~ "\ ~ State Cert. or Regist. 0 e,.c <br />Signa~ ~.......----- City License Registration 0 <br />*****...***.*.**************************** <br /> <br />APPLICATION APPROVED BY <br /> <br />PERMIT OFFICER. <br />