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<br />APPLICATION rOR PERMIT <br />CIT! or &EPHyaKILLS <br />BUI WIllG IlBPAR'l'J&lft' <br /> <br />@ <br /> <br />DAD UCIllVaD <br />PLAN, aYIW nil <br /> <br />JOB ADDRESS <br /> <br />I'i\, II ~0-e1\~ ~ah~ <br />3~ ~2Co q-l:. I <br /> <br />PHONI!: )'8"'8 - 31 D 7 <br /> <br />OWNER'S NAME <br /> <br />LEGAl. DE:3CRIPTlotl: LOTtS) BLOCK SUBDIVISION <br />PARCEL 10 11 i d. - ;) & -;) ) - b -=? 0 b ~f') fJl) 0 - (~l/::t'ROM <br /> <br />o MOVE <br /> <br />o DEMOJ.ISH <br /> <br />PROPF.ATY TAX NOT1~r.1 <br /> <br />o REPAIR (4.jNSTALL <br /> <br />WORK PROPSED: [JNEW CONSTRUCTION <br />[JSIGN <br />PROPOSED USE, [JSGL FAMILY DWELLING <br />OCOMMERCIAL <br /> <br />OADIlI'l'ION <br /> <br />o A l.rEMT I ON <br /> <br />OjlmL'l'I-FAMILY <br />o INDUSTRIAL <br /> <br />0# OF UNITS <br />o SWIMMING POOL <br /> <br />o MOBILE ROMI <br />~HER <br /> <br />D RES'l'AUIW~ HEALTH PEPARTMENT APPROVAL <br /> <br />DESCRIPTION OF WORK skA -t.-.~-b \ \ <br />. i 1\\/ I ~ <br />BUILDING SIZE ~ <br /> <br />SQUARE FOOTAGE <br /> <br />IdO, <br /> <br />HEIGHT <br /> <br />RESI!Jl!:I~TIAL: <br />COMMERCIAL: <br /> <br />ATTACH (2) PLOT PLANS , (2) SE'lS OF BUILDING PLANS" 11) SET ENERGY FORMS. <br />ATTACH (3) SETS OF BUILDING PLANS, (1) SET ENERGY FORMS. <br />PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. <br /> <br />)lSUT.LDIIIG <br />o ELEC'rRICAL <br />o I?tUMBING <br />o MECHANICAl. <br /> <br />PERMI'1'S REQUESTED <br />$ . 15DO.,DQ VALUM'ION OF TOTAL CONSTRUCTION <br /> <br />AMP SERVICE <br /> <br />o FLORIDA POWER <br /> <br />o W.R.E.C. <br /> <br />$ <br /> <br />VALUATION OF M8CllANCIAL INSTALLATION <br /> <br />o GAS <br /> <br />o ROOFING <br /> <br />o SPECIAL'rY <br /> <br />o OTHER <br /> <br />TYPE OF CONS'fRUCTION: 0 llLOCK <br /> <br />o FRAME <br /> <br />o S'l'~8L .p:.o'rHBR <br />I S PROJECT IN FLOOD ZONE AAEA.Q YES 0 NO <br /> <br />FINISHED FLOOR ELEVATIONS <br /> <br /> <br />COl-lPNJyB <br />STATB CERr OR REGIST <br />CITY PROCESSING . <br /> <br />C: <br />Dte ..,~ ~ :cr-a I <br />L~tenS~ <br /> <br />...,*-.*....*.~~..~.*.**.....*.....*.**.*r...*.*.*..*.. <br /> <br />ILl:C'1'RICI>>I <br /> <br />COMPA.'1Y <br />STATE eERT OR REGIST t <br />CITY PROCESSING # <br /> <br />SIGN1.TURE <br /> <br />...*...**..........l.*.~*.+**..*.......*.**.*..~...*.******....... <br /> <br />~ <br />SIGNATURE <br /> <br />COMPANY <br />STATE CERT OR REGIST . <br />CITY PROCESSING . <br /> <br />.*......*.*~..*...*.~*.....*.*....*.*........*..*...*~..**........ <br /> <br />MaCIWTICAl. <br /> <br />COMPANY <br />STATE CERT OR REGIS'!' W <br />~ITY PROCESSING . <br /> <br />SIGNATURE <br /> <br />...~...A.~.*.**...*..)...*'k*._.~....*.~....**..*................ <br /> <br />O'J'KEn <br /> <br />COM!.>ANY <br />STAT~ CERT OR REGIS'!' . <br />SlG/lJ\TUltE __________ Cn'Y PROCESSING" <br /> <br />.....k..'.*~...~~**...~.*...*t..~.~~*...*.~......**..*.~...*...** <br /> <br />..", <br />