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<br />CITY OF :G.I!i~t1.I!{n.L.l.d.lO .r~.EU.~""'~ o5"lIo...._________. <br />BUILDING DEPARTMENT 5335 8TH St, Z aphyrhiI Is , FL 33542 <br />813-780-0020 FAX:B13-780-0021 <br /> <br />DATE RECEIVED <br /> <br />0/2 2/~ <br /> <br />PHONE GONTACT FOR PERMITTING <br /> <br />OWNER'S NAME <br /> <br />lOR\ <br />SL\ \ \ <br /> <br />\\1, t'i\E'/RfL <br />--r:-e- no \, \, S ~. ~ '<- -\ <br /> <br />PHONE (er~) 783- 1'-{<..{'1 <br /> <br />JOB ADDRESS <br /> <br />/ tJY4 sT <br /> <br />. <br /> <br />LEGAL DESCRIPTION: LOT(S) <br />PARCEL 10 # )J,J~.;j./ 00/0 <br /> <br />BLOCK <br /> <br />SUBDIVISION <br /> <br />J.3~60 ooleO <br /> <br />(OBTAIN FROM PROPERTY TAX NOTICEl <br /> <br />WORK PROPSED: ONEW CONSTRUCTION <br /> <br />o ADDITION <br /> <br />o ALTERATION <br /> <br />~EPAIR <br /> <br />o INSTALL <br /> <br />Os I GN <br />PROPOSED USE:~GL FAMILY DWELLING <br />o COMMERCIAL <br /> <br />o MOVE <br /> <br />o DEMOLISH <br /> <br />OMULTI-FAMILY <br />o INDUSTRIAL <br /> <br />0# OF UNITS <br />o SWIMMING POOL <br /> <br />o MOBILE HOM <br />o OTHER <br /> <br />BUILDING SIZE <br /> <br />c=J RESTAURANT & HEALTH DEPARTMENT APPROVAL <br />~Q 9\o...c..e.. \=rovd: "boor ( ~e.~\c-.c~ Z l,-J \V"\~ows. <br />\. \) 0 $0..\+. HEIGHT <br /> <br />SQUARE FOOTAGE <br /> <br />DESCRIPTION OF WORK <br /> <br />RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. <br />IF SIGN PERM~T ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. ~J <br />PROPERTY SURVEY REQUIRED FOR ALL .NEW CONSTRUCTION. ~~ /, <br /> <br />/ l .~J <br />{C,U.. <br /> <br />PERMITS REQUESTED <br /> <br />~urLDING <br /> <br />$ I, 54 r . 51 <br />, <br /> <br />VALUATION OF TOTAL CONSTRUCTION <br /> <br />o ELECTRICAL <br />o PLUMBING <br />o MECHANICAL <br /> <br />AMP SERVICE <br /> <br />o Progress Energy 0 <br /> <br />W.R.E.C. <br /> <br />$ <br /> <br />VALUATION OF MECHANCIAL INSTALLATION <br /> <br />o GAS <br /> <br />o ROOFING <br /> <br />o SPECIALTY <br /> <br />o OTHER <br /> <br />TYPE OF CONSTRUCTION: 0 BLOCK <br /> <br />o FRAME <br /> <br />o STEEL <br /> <br />o OTHER <br /> <br />FINISHED FLOOR ELEVATIONS <br /> <br />IS PROJECT IN FLOOD ZONE AREAO YES 9(NO <br /> <br /> <br />BUILDER~'\ COMPANY <br />SIGNA;UR '.' C'll,. {\, mr STATE CERT OR REGIST t <br />********************~********************************************* <br /> <br />ELECTRICIAN <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST # <br /> <br />****************************************************************** <br /> <br />PLUMBER <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST # <br /> <br />****************************************************************** <br /> <br />MECHANICAL <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST # <br /> <br />***************************************************************** <br /> <br />OTHER <br /> <br />COMPANY <br /> <br />SIGNATURE <br /> <br />STATE CERT OR REGIST # <br />