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<br />CITY OF ZEPHYRHIIJLS PERMrr APPIJICATION
<br />BUIIlIJING I>BlI?ARTMEN'r 53315 8 th S'rREBI'r ZBlPHYRHII,I,S, Fl, 33540
<br />Phohe.B13-780-n020 FaxI813-780-0021
<br />!JA'n RBOJllIVJ!JIl ,_ _ ..,..c_
<br />InANe RlllVIBlW rJllJ...._,~.~'u
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<br />oWNeR'S HAM" ___ J~At1_J2tt'J:1/_ ____ ~______~______ ___ PHONm ('ON'I'Af'T3..i'Z-~d2t2.c
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<br />[JOB SITEl ADDREl88 ,-.:2-:ff."u:L_..j!! s:t.___________________________ -..------------.-.-'_.H ___ ___,_
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<br />LElOAL THllSt!RTPTIOll: LOT(S)
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<br />BfDC'K
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<br />SUBDIVISION
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<br />PARC1flJIJ III 1t_.!L_::..2.&..~)--.L::.{/.t2/t? ~-:t2Li!(ltl '/J / -uf((._____~_~~~~~~~l___~'.~)M _!~,r~=~~~'.~_'l'~~..~~~~teE1_~__
<br />WORK PROPSElD I []NEW CONSTRUCTION [) ADIJI'rIOt-T 0 AUI'ERATION II REPAIR LI INBTAf,I,
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<br />[Jsrrm
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<br />C) MOVE
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<br />rJ DEMOr,rSII
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<br />PROPOSEJIl USE I [JaGII, FAMIIJY DWELIJINr~
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<br />flt1tJI.'l'I. FAHII.Y
<br />
<br />[)# OF UNITS
<br />[]SWH1tUNG POUL
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<br />lJ MOB!I,El HOME
<br />LJ OTHElR
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<br />[] Cm1MIlJR(!IAf,
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<br />[J INDlJS'l'RIAJJ
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<br />11BJSCRIP'l'ImT OF 110RK
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<br />o RB1STAtJRAN'r & HElALTII DBlPARTt1ElN'I' APPROVAL
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<br />BtJILflINI] Ell ZEl
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<br />--_.__.--------..~------
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<br />SQUARE FOOTAGE:
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<br />"--- .----.-------
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<br />fl EI !I1H'r
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<br />....:"'"--".__.w _....._ __~.........__
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<br />RBlElII1ElNTIAT'l
<br />(~OMMmRr.!IAIJ :
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<br />A'!''f'ACH (2) PLo'r PI"A1l8 & (2) SElTS OF BUIT ,[)INC~ PLANS & (1) SElT ElNIllRnV FORMS,
<br />A'r1;A.CH (3) SElTS OF BUtLJJING PLANS & (1) SET ENER(~Y FORMS,
<br />PROPElRTY SURVEY REQUIRElD FOR ALL NEW CONSTRUCTION.
<br />
<br />FERMITS REQUESTED
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<br />[] BtJn.IJINr~
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<br />$
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<br />VALUATION OF TOTAl, CONs'rRtJC'l'ION
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<br />1.1 BlIJElCTRWAI.
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<br />------__.__ AMP SElRVICEI
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<br />o FInRIOA POWElR
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<br />[J W,R,El.C!,
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<br />[J PI.tJt18ING
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<br />U HHiUHAN T(JATJ
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<br />- VJ\I,UATION OF tIlElC'HANCIAI, INSTA.l,lJATTON
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<br />LJ RooP'Hm
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<br />LJ 8PECJtAI/l'Y
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<br />1'YPEJ OF COH8'I'Rt1C!TION I [J 8IJOCK
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<br />[) FRAME!
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<br />[J STEElIJ
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<br />[) OTHER
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<br />FINlSHElTl FI,OOR ElIJElVATIONS
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<br />IS PRO,lECT IN FLOOD ZONE! AREAO YES 0 NO
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<br />BUILOBlR
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<br />-------.-----------..----- ------------ ---..---
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<br />CotllPANY ---.-.~___..,__._. .___., _'__"___n_.,_.._._~.___,... .__
<br />STATE CElRT OR RElrJI S'!, # ~_____..__ ---_____c. ___'___
<br />CITY PROCESSING #____, _._____. _.._.___.____,.__ '__,__,_ _..
<br />
<br />E:llGN1\TtJREl
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<br />******************************************************************
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<br />B1r.JlIC'rRICtAH .. C()[1PANY~~~_.._____.______
<br />8]<3IJ '1' JR"" ~/ LJ. ~ ~T~TE C'8~T 0 ElC1#TS'l' # __________.__.._______..____,..___,___.....
<br />,A I CJ ... .- .~..:._. _ ____ CI ry PROCESSING
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<br />-------.--- ..,_._._~ _._.- -- . _._-_.__...__.~--_..
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<br />PI,UMBBlR
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<br />C~OM P ANY .----------_____n______._.._.._._____.. ._____.,...
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<br />STATE CERT OR REGIST # ________~,~.._.._.__....
<br />CITY PROCESSING #
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<br />SIlmA'l'tJREl
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<br />..--~-..._._-._--_....--..-._----,_._-.._---~._--_._..-
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<br />MBlOHANICAT. COMPANY _.___._._._._____.________..___.,..__.._,...
<br />STATEl (~ElRT OR REGrST # _____.____._.___,____._____.._,
<br />8IGNATU~rn CITY PROCESSING #
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<br />********************************************************k*********
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<br />--------.....----- -----._---_.-._.~..__._--._------_._-
<br />
<br />*****************'***********************************************
<br />
<br />OTHER
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<br />--------...--------------
<br />
<br />(~or,1PANY
<br />STATE C'ElRT OR REGIST #
<br />CITY PROCElS8INO #
<br />
<br />---------.-----..------. --..--... ,----- ,-..
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<br />._-...-._._.:..._-~------_.~-_._._-----------
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<br />8 I <3NA'l'UREl
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<br />---"-.'- ---"_..~.._-_....-_.__._.--- - _.. ~
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<br />*****************************************************************
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<br />--------- -. ..-.-.-.-.-.-----...--.----- '~-_.'---._----
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