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<br />APPLICATION FOR PERMIT <br />CI TY OF ZEPHYRlIlLLS <br />BUILDING DEPARTMENT <br /> <br />,--vi? p r3"'g'" <br />7 fJ O' ;.;1 <br />PHONE 3 (z.. - r-e s - </17 Z <br /> <br />JOB ADDRESS <br /> <br /> <br />OWNER'S NAME <br /> <br />j!t. 1J,f13 <br />2-e k "kll> 31 SYI <br />SUBDIVISION ~,Jt/'t/L ()A.~, 5~~ ~ <br />f1/::;:i-1;,JJ <br />PARCEL LD.t 01. - lAP - Z/ -tJooo - "t>l() 0 - (;)010 (OBTAIN FROM PROPERTY TAX NOTICE) <br />WORK PROPOSED:~New Construction ____Addition ____Alteration ____Repair ____Install <br /> <br />3G <br /> <br />LEGAL DESCRIPTION: LOT(S) <br /> <br /> ____Sign -"ove ____Demolish <br />PROPOSED USE: ASingle Family _M/F _f of Units _Mill <br /> _Commercial ____Indust, ____Swim, Pool _Other <br /> <br />DESCRIPTION OF WORK: <br /> <br />,...... <br />BUILDING SIZE: .> 0 <br /> <br />____Restaurant & Health Department Approval <br /> <br />~iS~ f~11 ~.~ , <br />D I tIS I /JkJ.,.fJ:I:-tAJ <br />X 5"l-, 2-1? ') Square Feet, 7J He1ght <br /> <br />RESIDENTIAL: <br />COMMERCIAL : <br /> <br />ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />ATTA~1 (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />PERMITS REOUESTED <br /> <br />4BUILDING <br />-4ELEC.JRICAL <br />-k-HEClIANICAL <br />4-PLUHBING <br /> <br />$ (P~(NI.I/ <br />J~O <br />3001> - <br /> <br />AMP Service <br /> <br />Valuation of Total Construction <br /> <br />X Florida Power Corp. <br /> <br />W.R.E,C. <br /> <br />$ <br /> <br />GAS <br /> <br />Valuation of Mechanical Installation <br />)(' ROOFING <br /> <br />SPECIALTY <br /> <br />TYPE OF CONSTRUCTION: 4Block ____FrUle ____Steel Other <br /> <br />FINISHED FLOOR ELEVATIONS: '10 FI. IS PROJECT IN FLOOD ZONE AREA? X <br />YES NO <br /> <br />****************************************** <br /> <br />BUIIDER <br /> <br />CONTRACTOR SECTION <br /> <br />~ COMPANY <br />State Cert. or Regist. f <br />~ -- City License Registration I <br />c. ****************************************** <br /> <br /> <br />/ <br /> <br />Signature <br /> <br />PLUMBER <br /> <br /> <br />COMPANY , '-"'/./ y..,...,;.' <br />State Cert. or Regist,' CFe... OYV11fXJ <br />City License Registration f t!J:) <br />****************************************** <br /> <br /> <br />51>' ~ / <br /> <br />ELECTRICIAN COMPANY Iov <br />= : ~ t' ~ State Cert. or Regist. . <br />u e City License Registration , <br />, <br />****************************************** <br /> <br />Signature <br /> <br />Signature <br /> <br />COMPANY ~ <br />State Cert. or Regist. f <br />City License Registration . <br />***************************************** <br /> <br /> <br />./ <br /> <br />MECHANICAL <br /> <br />OTIIF.R <br /> <br />,:A- <br /> <br />State Cert. or Regist.' C (:)0 <br />City License Registration f <br />*************************************** <br /> <br />COMPANY <br /> <br /> <br /> <br />Signature <br /> <br />APPLICATION APPROVED BY <br /> <br />PERMIT OFFICER. <br />