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<br />APPLICATION FOR PERMIT <br />CITY OF ZEPHYImILLS <br />BUILDING DEPARTMENT <br /> <br />, ,0,,'/ "j Li - ~ (jr i/' <br />I/)~U' '/ <br /> <br />OWNER'S "AIlE E ~ "-- \ :,.) l:---e- ~ <br />OWNER'S ~DRESS 'i>JJ ~ \01 ~p~ S bR <br /> <br />t,-l ?:HD?!!-? <br /> <br />JOB ADDRESS ~--"'-- a..s:. <br />LEGAL DESCRIPTION: LOT(S) <br /> <br />~~}~ <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />PARCEL I. ~;.f/ <br /> <br />(OBTAIN FROM PROPERTY TAX NOTICE) <br /> <br />WORK PROPOSED:_New Construction _Addition _Alteration _Repair _Install <br /> <br />_Sign <br /> <br />_Move <br /> <br />_Deaolish <br /> <br />PROPOSED USE: _Single Faaily <br /> <br />_M/F <br /> <br />_, of Units _M/H <br /> <br />_eo..ercial <br /> <br />_Indust. <br /> <br />_Swia. Pool _Other <br /> <br />_Restaurant <br /> <br />& Health Department Approval . <br />,;2 cJ' l j A{?-?, T- a,..,..,.,'Zc <br />Square Feet, He' t <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 />~LDING <br /> <br />PERMITS REOUESTED <br /> <br />$ <br /> <br />eE- <br />S- O{) . <br /> <br />Valuation of Total Construction <br /> <br />_ELECTRICAL <br /> <br />AtIP Service <br /> <br />Florida Power Corp. <br /> <br />W.R.E.C. <br /> <br />-"ECllAllICAL <br /> <br />$ <br /> <br />Valuation of Mechanical Installation <br /> <br />_PUJHBING <br /> <br />GAS <br /> <br />ROOFING <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION: _Block _Fraae _Steel <br /> <br />Other <br /> <br />FINISHED FLOOR ELEVATIONS: <br /> <br />FT. <br /> <br />IS PROJECT IN FLOOD ZONE AREA? <br /> <br />****************************************** <br /> <br />YES NO <br /> <br />BUILDER <br />Signature ,/-L'lkt.f'" <br /> <br />WRTBACfOR Sf'S _ ~ <br />~ QJKPAIIY ~. - YIY/R~ <br />f' State Cert. or Regist. , <br />~. City License Registration f <br />****.* *********************************** <br /> <br />ELECTRICIAN COMPANY <br />State Cert. or Regist. # <br />SignAture City License Registration . <br />****************************************** <br /> <br />PLUMBER COMPANY <br />State Cert. or Regist. , <br />Signature City License Registration # <br />****************************************** <br /> <br />MECHANICAL COMPANY <br />State Cert. or Regist. * <br />Signature City License Registration , <br />****************************************** <br /> <br />OTHRR COMPANY <br />State Cert. or Regist. * <br />Signature City License Registration . <br />****************************************** <br /> <br />APPLICATION APPROVED BY PERMIT OFFICER. <br />