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<br />OWNER'S NAMB f V e. ) ~)J '" ~ (. h,-t. N <br />.TOB SITB ADDRBSS 5 <(;as \:)0.11'0 tJ <br />LEGAL DBSCRIPTION: LOT(S) If b <br /> <br />~.L~l( UJf ~......_. ,."'!Ul.Lt.JJ~ .to. ~...'<..6!tIT AP'ILICATION <br />BUXLDXNG nBPARTHmn- 5335 atJa ST.BB'l' ZBPHYRUILLS. I'L 335..0 <br />PhoneaB13-7BO-0020 l'axaB13-780-0021' <br />DATB UCB:IVJID <br />PLANS RlIVIBIf nB . <br /> <br />PHONE CONTACT? ~3. b041 <br />Sf. 2~~h~r h,' II s ) r, '-- 33"S '1/ <br />BLOCK SUBDIVISION Tr -(~14l"-<.. V; 11 'I ~ <br /> <br />PARCEL ID It J t)- ~ /; . 'J J~ OOD\)-a~ J \)~_ ~<::) ~ ~ <br /> <br />(OBTAIN FROM PROPBRTY TAX NOTICE) <br /> <br />WORK PROPSRD: [JNRW CONSTRUCTION <br /> <br />[JSIGN <br /> <br />[JADDITIO~ <br />[J MOVB <br /> <br />[JALTBRATION <br />[J DEMOLISH <br /> <br />[J REPAIR <br /> <br />o INSTALL <br /> <br />PROPOSED USE: [Jsm, FAMILY DWELLING <br /> <br />OMUJ.TI - FAMILY <br /> <br />Olt 0l4' UNITS <br />o SWIMMING rooL <br /> <br />~MOBILE 1I0MH <br />o OTHER <br /> <br />[J COMMERCIAL <br /> <br />o INDUSTRIAL <br /> <br />PESCRIPTION OF WORK <br /> <br />o RBSTAURANT & HEALTH DBPARTMENT APPROVAL <br />Q(.Q,,~,", vJ)S:,,~k~Jy ~...bbe, 0evY\bC'..~ <br />//4 7 <br /> <br />SQUARB FOOTAGE <br /> <br />BUILDING SIZE <br /> <br />RESIDENTIAL~ <br />COMMERCIAl.: <br /> <br />HEIGHT <br /> <br />~~rACII (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />A1~ACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />PROPERTY SURVEY REQUIRED FOR ALL NBW CONSTRUCTION. <br /> <br />PERMITS RBOU.~TBD <br /> <br />~ BUILDING <br /> <br />$ <br /> <br />39 b b <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />o ELEc'rRICAJ. <br /> <br />AMP SERVICE <br /> <br />o FLORIDA POWER <br /> <br />o W.R.E.C. <br /> <br />[] Pl,UMBING <br /> <br />D MECHANICAL <br /> <br />$ <br /> <br />VALUATION OF MECHANCIAJ. INSTALI.I\.TION <br /> <br />o GAS <br /> <br />[] ROOFING <br /> <br />[] SPBCIALTY <br /> <br />o OTHER <br /> <br />TYPE OF CONSTRUCTION: [] BLOCK <br /> <br />D FRAME <br /> <br />D STEEL <br /> <br />D OTHER <br /> <br />!<'INISHED FI.OOR El.EVATIONS <br /> <br />IS PROJEC'r IN FLOOD ZONE AREAD YES D NO <br /> <br /> <br />BU'LDU ~ <br />BIGNA'I'URE ~ ' <br /> <br />~~~............................................................... <br /> <br />COMPANyJ 1/ lJ: l"I ~,b/e. As: 5 0 c.. <br />STATB CBRT OR REGIST 4# C c::: c. 0 L( 9 :3 b 7 <br />CI'I'Y PROCESSING 4# .3 0 Cj <br /> <br />BLBCTRICIAN <br /> <br />SIGNA1'URE <br /> <br />COMPANY <br />STATE CERT OR RHGIST It <br />CITY PROCESSING 4# <br /> <br />.................................................................. <br /> <br />PLUllBBR <br /> <br />COMPANY <br />STATE CERT OR REGrST 4# <br />CITY PROCESSING 4# ' <br /> <br />SIGNATURE <br /> <br />H.CHANICAL <br /> <br />.................................................................. <br /> <br />COMPANY <br />STATE CERT OR REGrST 4# <br />CITY PROCESSING 4# <br /> <br />SIGNA'I'URE <br /> <br />................................................................. <br /> <br />OTHB. <br /> <br />SIGNA'l'URE <br /> <br />COMPANY <br />S'I~TE CSRT OR REGrST # <br />CITY PROCESSING 4# <br /> <br />..............................*............t~................... <br />