|
<br />'-"....... ... ..
<br />
<br />'.100 .......... U . "\.u ~ .w.w p ,I;" oCI&\~,U. .1' 1\.1:' .I:' .1~ l.l;1\ l' ,!, l)1'!
<br />DBPAR'I'MBlN'l' 53J5 ~th S'fRlllBl'I' ZBli'H'iRHILI,S, Jj'I.. 33540
<br />~hon~18i3-?80-~020 FaxI813-780-00~1
<br />IJA',L'1lI :RllImUVBlO __'_'__'h,. .~..__.__
<br />pr..\liJf:I RHlV rlllW fDB
<br />
<br />:aUILDING
<br />
<br />.
<br />
<br />nl/Hh:R I S mll\'Jh:---2A~ ~-----___'_'h_____"_'__________ PHONE C()N'l'M~'~____~._.____.__.___
<br />,JUS S I'l'liJ ADmHiJSS_ 0-tJLh _..L z T~___~ ~________________________.___
<br />
<br />--..-~, .... .-----..-.---. .._...-.-.... ......."~_.~.
<br />
<br />l,llH,AL nlllt:j(~kIP'rrONI LOT(S)
<br />
<br />BI.oeK
<br />
<br />I:HIBIHVIsmN
<br />
<br />-.
<br />
<br />-..,.--.-.------.-
<br />
<br />l?A1Wlia. ID #
<br />
<br />---_._._-----_._-.~-_.,-...-.....~-_...._-_..._..---
<br />
<br />(OBTAIN !;<'ROM l?R()};I!llR'l'Y '1'AK lW'l'JpJjl)
<br />
<br />HI-JRK l-ll:tcJHlliJIJ; lJl~EW CDNS'l'RWJTION
<br />
<br />[] AOIn'l'ION
<br />
<br />[] ALTElRA'l'JON
<br />
<br />[] R!llPAIR
<br />
<br />[J mS'I'M,I,
<br />
<br />[JSHm
<br />
<br />[J lVlOVEl
<br />
<br />[J DEI'1OI,ISIl
<br />
<br />l?RCll:'Uf:jEll USE: LJ~K:llJ FAMILY DW!llLLIHGl
<br />[](]OMMIiJRCJAl,
<br />
<br />[JrIlUI/l'I - FAMU,Y
<br />
<br />0# OF mu'l'S
<br />DSWH1MIHG POOl,
<br />
<br />f] MDarl,E llnME
<br />IJ O'flUliR
<br />
<br />o INPllE!'l'RIAI,
<br />
<br />nE8CRI~TION OF WORK
<br />
<br />D R&lSTAURAWl' & HEAW'H DEPARTMEN'L' APPROVAL
<br />-k:d2 bj?~-LJL( ~r: C~M~_ LJ~csk~.
<br />SQUARE F'OOTAGE 1l1:llli:iIl'I'
<br />
<br />........._---.~---_._-
<br />
<br />BUII,nmG SIZE
<br />
<br />--~----~_.--
<br />
<br />------------
<br />
<br />RliJSHiEl~'rrhTJ I
<br />COI>1I\1H1RCIAI'1
<br />
<br />.~-..-_,..,...-.,...-,.._--_.
<br />
<br />A'r'l'ACH (2) l?LO'1' I?J"AllS E. (:4) SE'rs OF' EltJIl,lHIKJ PI,AHS 6< (1) fjtil'I' ~NJj)RI,l{ li"}RM~L
<br />A'l"l'AC!H (3) SE'rs OF BUILn:rNG PLANS " (1) Sl:il'l' ENlilkC3Y FORMS,
<br />I?ROPERTY SURVEY REQUIRED FOR ALL NIilW Cm~S'l'RUL"I'InH.
<br />
<br />F~RM~T~ REQUE~TEn
<br />
<br />LJ BIJIl,I1Hlf3
<br />~LEl~'J'R 1. CAI.
<br />[] I?l,lllvJ1HIKI
<br />
<br />$-------__ VALIJATWN OF 'l'O'l'AL CONS'l'RU(;'I'ION
<br />
<br />~i)
<br />
<br />A1"11? SERVICE
<br />
<br />~ FI,ORrDA I?OWER
<br />
<br />o W,l(,El,':,
<br />
<br />o 1'1&lCHAlH CAI,
<br />
<br />9___.
<br />
<br />VALUATIOl~ Of' MECHANC;IAJ, INS'l'AJ.J,A'l'ICJH
<br />
<br />[J CiAS
<br />
<br />[] ROCJl"llW
<br />
<br />[] SI?li:C1I.4l/l'i'
<br />
<br />o O'l'HER
<br />
<br />'J'V!?jjJ lJl.' COm:l'L'RLJC'f'WN; [J l:$J,OCK
<br />
<br />o F'RAJIlE;
<br />
<br />lJ S'l'EJEL
<br />
<br />o OTHER
<br />
<br />!"HnSHJiJfj FI,Of)}t EI,EVATIONS
<br />
<br />IS f.JROOJEC'l' IN }<'1,OOO ZONE AHEA[] \'ElS
<br />
<br />IJ I'll!
<br />
<br />
<br />III U l'LlHllli
<br />
<br />* * .. .. .. I. .. I.. * I. .. .. I. I. * I. . ;; . * .. * * * ;; * * '" . /; I< I. .. . '1. I< -); .. .. 'k .. . . * ;; . . * .. .' . * /; * .. .. .. * * . \\ .. * iii * .
<br />
<br />CWIII?ANY_______._
<br />13'1'1\'1'.II: ClliWl' OR REG:rST # ...._d.._.___.____________.
<br />CITY PROU~SSlNG #
<br />--.----...--..---.--..------........-----......-......--
<br />
<br />--'.................--....--.,.--- .'---.-.,-.
<br />
<br />S1l3NJ\'I'U,Rl:J!
<br />
<br />----_.-_._--_..._-------------~----~-
<br />
<br />!U.JIlC'.l'lUCIAU
<br />
<br />
<br /><---~ -
<br />
<br />COJIII?AHY ~'1rb"'1 &I~~JZj~~_~~
<br />STATE: CEWI' OR RE:G I 8'11~' ~;# / 3 ?Ll.~
<br />'. . ~~_~~ DO
<br />CITY PROCBL8SINf# # .' ------.-- -_ _,_,,_._..._
<br />
<br />~-2_____.~_,_..___.._.___..._,___.,
<br />
<br />t:lJl::lHA'I'l1RE ___...
<br />
<br />I..~*****~**..***.~*.**..****.*.*.*********************."..**...,.t
<br />
<br />i>LUW:aIilR
<br />
<br />-------.----.----.--
<br />
<br />COMI?ANY-________.,...~~_..____.__._____.___..__
<br />
<br />STATE: CElR'l' OR JtEGIST ,. ___________________
<br />CITY PROCESSING #
<br />
<br />S IG!1A'l'IJRlli
<br />
<br />WHlCHAlUCAI.
<br />
<br />*."..*****t***********_***********,******,..****.****i*i**'***,*,
<br />
<br />._.--....-._~_._--~-----_.-
<br />
<br />COlvJPANY___
<br />STA'l'E CIllR'l' OR RE:CHS'l' #
<br />CITY PROCESSING #
<br />
<br />'--'.--"~"__~"M_"~",____~___,_,,,,,_.,-,-,.~,__,
<br />
<br />SH#NATlJRE
<br />
<br />------.
<br />
<br />-_._----.~--_.-----~--
<br />
<br />*t*;;***i**.~*****..******I.**'********.*~*******.*******..i....****
<br />
<br />....------,..._-..._.-....--..--~
<br />
<br />O'I'HJilR
<br />
<br />~_._-_._--~-----. -----
<br />
<br />Cm'1p)\NY
<br />STATE CERT OR REGrST #
<br />CITY I?ROCESt:lINGl #
<br />
<br />----...-.-..-...-..-.....----.-.-..
<br />
<br />S HmA'J'URE
<br />
<br />----.-------..---
<br />
<br />------.- '.~ ~---- '--"~-. ..,----......-""77 .-.....--......-
<br />
<br />*it***t***********************....*******************************
<br />
<br />--------,-.....-.----.-....---.- --.-".... 'r-'_ _~-.-,.......___.__"
<br />
|