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<br />P.Ol
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<br />APPLICATiON FOR PERMIT
<br />CITY OF 7.F.PHYRlfll.LS
<br />BUll.1> LNG DEPARTMENT
<br />
<br />Lor
<br />OWNER I 5 NAHF._'__.-1;J'l.\'t.:.c.u Il.,.j:~t?'U~~-~G.~S?_~...___~PIfONE___..=l..Rj(. .1.1 '1 i-
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<br />OWNER' S AlJURF~<;S_..._." .~L~.':~L..... r=-\.!,~i:...b'-f....sJ_._.~ L.,../ {V--~....
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<br />--
<br />
<br />JOB ADDRESS___
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<br />~::: t,\ L 1 \ '--c...-
<br />,', ,~---,-- ," 'YVi-.-------.-..'"'
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<br />LOr(~;)___L'S"Lf _"" \a81~~J\hl+-<. S~~iVISION_
<br />
<br />. ...- i
<br />ta\ ~ t CkP
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<br />LEGAL DESCR1PTlON:
<br />
<br />PARCEL 1. D. ,__.___._,
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<br />...~------ ~--_.-..._----,-.--- .,_-108T~
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<br />WORK PROPOSED:_New Goustl'UCUoU _Addition __Alteration
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<br />~_Sign
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<br />___Ho\l e
<br />
<br />_IJe.olish
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<br />PRuPOSEO UJt: _Sill,de F'ami.1y
<br />
<br />___._111 f
<br />
<br />__, uf Units
<br />
<br />___MIll
<br />
<br />_,_eo..ercial
<br />
<br />"___~Indus t .
<br />
<br />~Swllll, Pool
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<br />_Other
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<br />__Rest.SlInlllt ,. Health Departmenl Approval
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<br />DESCIUPTION OF WORK: __''''''_ "_'_~_ _ _'_'''_.._____________
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<br />BUILDING SiZE: --,-'C-..---,~,._____squan: Feetl~_Height
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<br />RES IUEH1'IAI.:
<br />COHMERClAL :
<br />
<br />ATTACH (2) I'LoT PLANS [. (2) SETS UI:-' BUl.LOING PLANS & (1) SET ENERGY FORMS,
<br />ATTAGIl (3) SETS OF aUILlHNG PLANS [. (1) SET ENERGY FORMs.
<br />PROPERJ'V SU~VEY RE;QUI REO fOR AU. NEW (;ONSTRUCTlON.
<br />
<br />fERM I Ts.._MmLtSll:!!
<br />
<br />_BUlLIHHG
<br />
<br />$,,^._---._..__.._ValuaUol1 of Total Construction
<br />
<br />~ELECTR I GAL
<br />----1lECIlA.H 1 (;AI.
<br />
<br />_.lC?_~.AHP Sel" ice
<br />
<br />______Florida Power Corp.
<br />
<br />W.R,E.C.
<br />
<br />$-..-,.-.-.,'_"___VttJunlion o( Kechanh:al Installalion
<br />
<br />_PLlJH.BING
<br />
<br />"'_~__._. ,._ ,(.;A!:i
<br />
<br />..___.ROOf'lNG
<br />
<br />._SPEcIALTY
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<br />TYPl-: OF CONSTRUCTiON: ___,Bh1ck
<br />
<br />.-~F["Q.e.~_Steel
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<br />_Other
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<br />YIlHSUED FU>OR EU.:VATIONS ;~_._.___FT .
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<br />IS FROJE~f IN FLOOD ZONE AREA?
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<br />._**......_..***...*****....**.......**...
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<br />YES NO
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<br />~~tRAG10R_~ECTXQH
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<br />BU1~
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<br />Signature
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<br />COHPANY~_,,__.
<br />State Cert. or Reglst. ,
<br />..~ City License Re.eistralion t
<br />**.......*........****........****.......*
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<br />E~('"TRICI,AN& ' ,//7/(7/' COKPANYLt?.c"'~. CZVt/ r_ ~r .
<br />. . ~(//,-;:;{Y ~f)A-, S~ate Cert. or ReQhl. ,ES'OtJ006 (/
<br />:iialli!1IWU:'. .. ~C<,-k.l2~<''-' _ Or I.y License Registration . I q
<br />.......*........**.........*.*......****...
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<br />n\ll'UlW! GOMPANY__________
<br />Slate Cert. or Regist. t
<br />Signature -----_.~____,___._.__ City License Registration t
<br />..............................*.*....*.**.
<br />
<br />--
<br />
<br />KECHAtil~
<br />
<br />Signature
<br />
<br />COHPANY_,. _.
<br />Slate Cert. or Regist. #
<br />----~_u"..._. ____..~ City License Registration'
<br />.***A...*..~.*.*~*.****.**...*...**.*...*.
<br />
<br />2IlIl&
<br />
<br />Signature
<br />
<br />COHPANy_
<br />Stste Cert. or Regist. D
<br />--..~~._'_.__._----- City License Registration f
<br />...............................*.._.......
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<br />APPLICATION APPROVEO BY
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<br />-----.--.--....-...--.-.--.....
<br />
<br />PERMIT OFFICER.
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