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<br />,-" ""'~'--'~,~ 'f"'-"___" <br /> <br />APPLICAnON FOR PERK1T <br />CITY OF ZEPIlYBIIILLS <br />BUILDIliG DEPARTKEIiT <br /> <br />OWIiER.'S UHE ('V\~J~\~ <~.H~.r <br />OWER'S ADDRESS ~ ~ \ \ \\ 'tt\. S\ <br />JOB ADDRESS $ c..oN\.e. <br /> <br />PHONE <br /> <br />')\~ ~~~~ <br /> <br />-....... <br /> <br />LEGAL DESClUPlION: LOT(S) $} ~).....\D B~SUBDIVISION-C-;;U)\A tsC "'2-\.t.~_U~ <br />PARCEL LD.'--ll ':l-b')-, (\')f1\n- \ \ QOO -(")6""\0 (OBTAIN FROM PROPERTY TAX NOTICE) <br />WORK PROPOSBD:~ew Coastruction ----Addition ~teration ~ir _Install <br /> <br />-5ign <br /> <br />-.--JIove <br /> <br />-Peaolish <br /> <br />PROPOSED 'USE: _Single Faaily <br /> <br />----3f./F _' of Units ----3f./H <br /> <br />_ec-ercial <br /> <br />_Indust. _Swia. Pool _Other <br /> <br />~estaurant 6: Health Departaent Approval <br /> <br />DESCRIPTIOII OF WORK:~4..;lr J Rp~.....(.\J tC:',e,N~e. <br />I <br />BUILDIliG SIZE: X ~e Feet, Height <br /> <br />RESIDEJITIAL: <br />COMMERCIAL : <br /> <br />ATTACH (2) PLOT PLAliS 6: (2) SETS OF BUILDIliG PLAliS 6: (1) SET EliERGY FOBHS. <br />ATTACH (3) SETS OF BUILDIliG PLAliS 6: (1) SET EliERGY FORKS. <br />PROPERTY SURVEY REQUIRED FOR ALL IIEW CONSTRUCTION. <br /> <br />PERMITS REQUESTED <br /> <br />~UILDDlG <br />~crnCAL <br /> <br />$ <br />-:LoD <br /> <br />Valuation of Total Construction <br />AIIP Service /:lorida Power Corp. <br /> <br />W.R.E.C. <br /> <br />----llECllAllIc&L <br /> <br />$ <br /> <br />Valuation of Kechanica1 Installation <br /> <br />-PL1RIBDlG GAS ROOfiliG <br />TYPE QF mIISTRUCTION: -----Bloclt _Fraae _Steel <br /> <br />SPECIALTY <br /> <br />Other <br /> <br />FI.IIISIIBD FLOOR ELEVAnOIlS: <br /> <br />FT. <br /> <br />IS PROJECT III FLOOD ZOO AREAt <br /> <br />YES NO <br /> <br />.......................................... <br /> <br />COIiTRACTOR SECTION <br /> <br />COlIPAIIY <br />State Cert. or Regist. . <br />City License Registration . <br />.......................................... <br /> <br />RIITI.DRR <br /> <br />Signature <br /> <br />Rl.RCTRICIAII COHPAIIY j';: c:: e: <br />/ _ //. l _ t 4 State Cert. or Regist. . ~~~/7~ #6~cJ <br />SianAture ~../~~ ~~ City License Registration' Ld'.d <br />.......................................... <br /> <br />PLUKBER COlIPAIIY <br />State Cert. or Regist. . <br />Signature City License Registration . <br />.......................................... <br /> <br />HECRAHICAL COHPAIIY <br />State Cert. or Regist. . <br />Sigoature City License Registration . <br />.......................................... <br /> <br />nTRRR COHPAIIY <br />State Cert. or Regist. . <br />Signature City License Registration . <br />.......................................... <br /> <br />APPLICAnOIl APPROVED BY PERK1T OFFICER. <br />