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<br />APPLICATION FOR PERMIT <br />CITY OF ZEPIIYRlIILLS <br />BUILDING DEPARTMENT <br /> <br />OWNER'S NAME <br /> <br />'}-A~C) ~ <br />5'5~4 J 1 rn. ~ T ) <br />,-<SA- M. ri.- ~ <br /> <br />PIIONE ~ I 3 - 7 (l3 - <;('?FFl <br />"Z.6P/..!Yf? HILt ~l FL. .3~~4c <br /> <br />OWNER'S ADDRESS <br /> <br />JOB ADDRESS <br /> <br />LEGAL DESCRIPTION: LOT(S) 0 l5c <br /> <br />BLOCR.}c4oo SUBDIVISION 00 I c <br /> <br />PARCEL J.D.' ~ } / <br /> <br />/Lb Q'L.\ <br /> <br />(OBTAIN FROM PROPERTY TAX NOTICE) <br /> <br />WORK PROPOSED:____New Construction ----Addition ~Alteration ____Repair ____Install <br /> <br />____Sign <br /> <br />_Hove <br /> <br />_Demolish <br /> <br />PROPOSED USE: _Single Family <br /> <br />_H/F <br /> <br />____, of Units ____H/H <br /> <br />____COIIBercial <br /> <br />_lndust. <br /> <br />____Swim. Pool ___Other <br /> <br />____Restaurant & Health Department Approval <br /> <br />DESCRIPTION OF WORK: <br /> <br />.6rzR-Vll!6: u..P ('~AD~ % JS0AMP I fl!! <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 />ATTACII (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PERMITS REOUESTED <br /> <br />____BUILDING <br />~LEC1'RICAL <br /> <br />$ <br /> <br />)60 <br /> <br />AMP Service <br /> <br />Valuation of Total Construction <br /> <br />~lorida Power Corp. <br /> <br />W.R.E.C. <br /> <br />____MECHANICAL <br /> <br />$ <br /> <br />Valuation of Mechanical Installation <br /> <br />____PLmtBING <br /> <br />GAS <br /> <br />ROOFING <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION: _Block. _Fra.e _Steel <br /> <br />Other <br /> <br />FINISHED 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 />BUILDER <br /> <br />COMPANY <br />State Cert. or Regist. , <br />City License Registration' <br />.......................................... <br /> <br />Signature <br /> <br />~ ~ COl\PANY~R- EL-rzerrz.!e <: tZ~V/,'Fi:_ <br />JJc;rIC . s~ate Cert. or Regist. t FIL(S~;..'.J-:f <: <br />u e ( C1ty License Registration t <br />~ . ....................................... ~ <br /> <br />PLmtBER COMPANY <br />State Cert. or Regist. t <br />Signature City License Registration # <br />.......................................... <br /> <br />MECHANICAL COMPANY <br />State Cert. or Regist. # <br />Signature City License Registration . <br />.......................................... <br /> <br />OTHF.R COMPANY <br />State Cert. or Regist. , <br />Signature City License Registration , <br />................................*......... <br /> <br />APPLICATION APPROVED BY PERMIT OFFICER. <br />