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<br />'/ L' LH!,.t;" n:t. rttu, 111.t:l .1:' Ha~M.l '1' APPl.d:CATION
<br />BUH,IlHW /J.B:PAR'nlI!1N'r 5335 sth STRllll!J'L' Z!IIPJlYRHII,I,S, Fl. 31540
<br />Phone.813-'lSO-0020 Fa,cI813-780,-0021
<br />IlA'fH RHOHIVBJD ---.._"'__h__, _.,.,
<br />PLANS RHVIBW FHH
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<br />I OWN.IlJR I B l'IM1Bl
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<br />--..---.----.-.--.--....------
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<br />PHONE CONTACT
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<br />JOB SI'l'm ADDRESS
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<br />._._---..-._---_._.-----_...__._---~ .------.-----..- '-_. --...-
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<br />I,SlGAL DllIBC'RIP'!'IOH I LOT (8)
<br />
<br />BLOCK
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<br />SUBDIVISION
<br />
<br />PARcmL ID jl
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<br />------
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<br />WORK PROPSBlD I 0 HBlW (!ONS'fRtJC'rION
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<br />(OBTAIN F'ROM PROPERTY TAlC NO'I'lCHi)
<br />
<br />[] ADDITION
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<br />-----.-.-------.--
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<br />[) A Ul' liJ RAT ION
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<br />[] REPAIR
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<br />IJ !H8'1'Af,l,
<br />
<br />CJSlGN
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<br />fJ NOVE
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<br />[] LJEtJIOLISII
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<br />PROPOSBlU IJSIl: I [JSG!., FAMIl,y DWEIJLING
<br />
<br />OlvllJL'rI - F'AMtJ..Y
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<br />0# 011' UN1'1'S
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<br />LI t10BH,Hl HUT/Hi:
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<br />[J (!Of.1MBlRCIAl,
<br />
<br />[] INDUSTRIAl.,
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<br />OSWIf.1MIN(~ poor,
<br />
<br />IJ O'T'llBlR
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<br />0, RESTAURANT & HEAL'l'H DBJPAR'!'MENT APPROVAl,
<br />
<br />DESCRIPTION OF WORK
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<br />M_____.__.____..._._.___.._______._______.___
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<br />BlJn,DING SIZID
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<br />--.--------.-
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<br />SQUARE FOOTA(~E
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<br />RillS I1JJllU'l'I AI, :
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<br />IIBlIl.3I1T
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<br />A'!"l'1\CH (:d) PL.OT PLANS & (:2) SETS OF BUIlJnlNt~ PI,J\N8 & (1) SET ElNERGt' P'(JR~18,
<br />ATTACH (3) 8ElTS OF BUIf,Ullm PLANS & (l) 8ElT ENERGY FORMS.
<br />PRuPERTY SURVEY REQUIRED F'OR M,l, NBlW CONSTRUCTION.
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<br />_._-_.-..__._~--..
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<br />flRMIT~RiQUmSTED
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<br />o BllJ:LIllNG
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<br />
<br />VALUATION OF TOTJ\l. conS'l'RUCTION
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<br />Ll Ell,EC1'RlCAl,
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<br />M____
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<br />AMP 8ERVICBI
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<br />LJ
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<br />F'I,ORIDA pm~ER
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<br />\'l.R.B1.t!.
<br />
<br />[) Pl,UMBING
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<br />[] IvIECHAIHC1\L
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<br />$..-
<br />
<br />VAr~UATION OF' MECHANCIAIJ IN8TAI/f,A'l'ION
<br />
<br />LJ (~A8
<br />
<br />U RUOF 1N(3
<br />
<br />1:1 SPECIAUl'Y
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<br />IJ OTHER
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<br />'I'Y~BJ OF CONS'l'RUC'l'ION I I.J BLOCK
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<br />(J FRANE
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<br />C) 8TEBllJ
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<br />[J OTHER
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<br />FllHSIIED F'I,c)UH Ell,EVA'!'JON8
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<br />IS PROJECT IN FLOOD ZONm AREArJ YES
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<br />CI NO
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<br />Burr,rlBR
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<br />COMPANY _..___ _.__.
<br />STATE CElHT OR RBKHS'!' It _____'_____...,_..,...__
<br />CI'fY PROCSlBSINr1 1L___._________,_____..,.
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<br />SWNI\'l'URIll
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<br />B1LBC'l'RWIAN /J
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<br />PLUMSBJR
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<br />COr1PANY--___,_________...________"..,._h. ...
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<br />STATE CERT OR RBlGIS'I' # _ _'_..h_._...._,_.._
<br />CITY PROCESSIN(} It
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<br />8 WNATl1RllJ
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<br />MI:ICHANIC1AI.
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<br />COMPJ~NY ___,_,_..
<br />STATE CBlRT OR RBJC.HST II ____________.,_,_,__,...._...
<br />C11~ PROCESSING #
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<br />SlmU~'l'{JRBI
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<br />*************'*.*'*'****'***************"**"****************'**
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<br />-----------.- --
<br />
<br />O'l'HBlR
<br />
<br />CO~IPANY
<br />S'I'A'l'Bl CBlRT OR RBlGfST'1r
<br />CITY PROCESSING # -'---._____.___.__..,_.
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<br />SIGNATURE
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