HomeMy WebLinkAboutCamScanner 06-23-2020 13.25.26ub mi�k�ls �'
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All APPLICABLE INFO MUST BE CaM?LE•TEd FOR APPL�CATIC#N TQ ESE ACCEPTED
pate:
Perini[ Number:
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-5 � �� �'
�� Building Permit Application ///
PJo�nln� arrd �vefopmer+f Services /
au��dmq urrd Code �Cgeafotiorr Div+s+an CommerCla� Residential IVI
130� lfrrgirriQ ltverrue, Fort Prerce FZ 3�9$2
Phone: {77�j 462-1553 FaX: (7T�j 4G2-15�8
P1rRN117 APPLIC�TIpN FIR: �� � � r,1G1�C, 11'l�-T-�` ��� A i �`
Address.
Property Tax ID P: �� �� � (] 4 '� �C7 ��= Q p o � C� Lat No-�
Site Pian Name: Black Nn,
Project Name:
��r�i�.E���tPnon� �
New Elet-tr�cal MI?rer
Second Elertrital Meter
Add'rtianal work to be performed under this permit —check all that apply
EeChani€al � Gas Tank ^Gas Piping � Shutters
lectric � Plumbing _sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ D
_Generator
`Windows{Doors � Pond
Sq- Ft. of First Flaar:
Roof Pitch
tJtilitles: _Sewer i septic Building Height;
htamE ��t-Flpay � � ��{t� l.} t �SatJ
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Address: � � O � . � • � 7 Tt�4� T
City: #'off-�_� t�i�,t''C,'� State: � t-
�ipCode:.�+�� Fax:. -
Phone N4. 5 t � y - 11'�
E-Mail:
fill in fee simple Title Holder an next page � If different
from the Owner listed above)
Ndme: �J,�l,a►rJ .3 nq .Y
Company: � • �',rr� r��� � � � n
Address:�� f.�P4k.LrA..1a f�fl+Ct Gir*
City' !C� }'S;� r.e�p-_ _ 5tate:�
Zip Code: ;���_� 1 Fax:
Phone IVa i � i + 7
E-Mail �' • '�/�-4�T� �_`Qr�rig� �.Zflrtiktiil�_.
State ar County License ��, �� �}�l � �- �-f �
If value of construction Is Z540 or more, a Rt`CORDEa Notice of Commencement is required.
IF value of HAVC is �7,540 or more, a RECDliI]EL] Notice aF Garnrnencement is required,
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