HomeMy WebLinkAboutHensley AC Permit App pg 1 001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: $ �la� �q Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fart Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT^r,I'LOCATION:
Address: 72i"'TA. C)00 � �Yi /,1666 BIudFDf-� PjC((e_ ? �L 34R5 (
Legal Description: XA'P(a,(IC d4,i ' " 1-- ]MSC, 102 iL4t 23
Property Tax lD #: (50 WO (, S - 0069.-100 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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sustem W IfIn ( o Kw hest•
CONSTRUCTION INFORMATION:
rk to Bee orme under tispermit-c ec a app
_ HVAC El Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
Electric 1:1 Plumbing Osprinklers Generator El Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 5900.00 utilities: OSewer FSeptic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name:
Addres :
City: T ((i'(Q State: R"
Zip Code: 34g51 Fax:
Phone No.71a-5Rij -(813
Company: (
Address:516: P; T[,(,(yl�fk . E
City: fbnb I (P1CPi State:_
Zip Code: 3"51 Fax:i?.?4 373-7
Phone No, -"A- LLQ[-41)� J
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:(I {j00 • �8 (Yi
State or County Licen e: CAC,1'9 �) $
u vame or conscrucuon is pcow or more, a ntCUKUW nonce or Commencement is required.