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<br />CITY OF ZBJPUYRHIIJIJS PERMr!' APPI.J!CA'l'ION
<br />Burr,nnlr~ lJ.IllPARU-tBlN'f 5335 B th STRBl!!J'f ZIII?IIYRHII,I,S, FJ, 3J 54 0
<br />PhoneIB13-180-0020 FaxI813-780-0021
<br />DArfll RJlOJllIVIID ____' '_'_""_ "_
<br />InANS RIlIVIBW FIlIII __..____
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<br />PARCElL III i~
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<br />WORK PRUPSElD, ~I!JN conSTRUCTION
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<br />(OBTAIN FRor'l PFHJPBJR'l"{ TAX NOT[C!E:)
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<br />lJ 1'111 un - F'ArlI L't'
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<br />lJ# OF UInTS
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<br />f~I'IIER
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<br />[=1 RBlSTAURAH'l' & HE/Uim DElPAR'1't'1EN'l' APPROVAl,
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<br />RI1)8 IIJfllN'l'IAL:
<br />COM~1EIR(!I/U, :
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<br />l\'l"l'ACH (2) PLO'l' PLAITS & (2) SETS OF BrnI,nINt~ PJ,Al-18 & (.I) BElT ENERGY FORt.IS.
<br />A'I"J'l\ClI (3) SEITS OF BtJlf,!JWG PLANS & (1) BET ElNERGY FORf18 ,
<br />PRuPElR'l'Y SURVEY REQUIRED F'OR AI,I., IH!lW CONSTRUCTION.
<br />
<br />l?ERMI'l'S RBlQUES'fED
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<br />[J BlIJ:LJlJ Hl.3
<br />[) El,BJC'I'fU (~A I,
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<br />$ -ul){) ~t2_____ VAIJIJA'fI()II OF TOTAL, COtlS'l'RIICTION
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<br />AI.1P SERVICE
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<br />Ll P'f,fJRIDA l?ONER
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<br />[) W.R,E,C,
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<br />U (~AS
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<br />U IH)OF IN13
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<br />fJ SPECIAUl'Y
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<br />lJ OTHElR
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<br />'l'Yl'llJ OF' CONS'I'Rl1C'l'lON I f] 8IJOCK
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<br />[J FRANEJ
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<br />Cl STEEL
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<br />[-i' !lHSIIED P'LDun EJIJEVA'1'JONS
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<br />IS PRC),JElCT nl FLOOD ZOIlE AREAL! YES
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<br />STA'1'EJ CERT OR RIllGIS'1' II .__'__...'_____,_______...__... "___'"
<br />CITY PROCESSING #
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<br />mLJllC'l'RICIAH
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<br />COlvJPl\HY..._,_____.._ ....-____....n_,_.._..___...._..__ __.
<br />STATIi) CERT OR REIHST #
<br />CITY PROCE8STNfJ #
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<br />.---..-.-----. '----~-.__. _h_ ___
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<br />PIJUMBJllR COl-1PANY-___________,.._____...____,..,_____._ _._
<br />STATE CER'!' OR HE)G1.8'l' # ________.__,..._,.._...._
<br />8 WNATlJREl CITY PRCJCESSnIn #
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<br />COl'1P ilN Y _____'________...___.____,___ ._________
<br />STATE ('EJRT OR REJI~ IS'1' II
<br />CITY PRUCElSSIW~ 1/
<br />
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<br />S ImUITURE]
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<br />C()[\IPANY
<br />S '} '1\ rrE: (; ER TOifREGiST...-#.----~-----~ --~--_..__.___...,.._"~ ..__._..
<br />C'I'l'Y PROCESSING # --.....___.._.___,____..~_.___
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<br />SIGNATURE
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