HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:12 - 14 - 2 a 2.D
Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential_
2300 Virginia Avenue, Fort FL34982
Phone: (772) 462-1553 Fax:ax: (772)462-62-1578
PERMIT APPLICATION FOR: Z SCYV ICf5 On -Ri qn Cu) fure PrQxyzd::�
PROPOSED IMPROVEMENT LOCATION:
Address: % ION MPQ e blaV, ibKt P)WP --L
Property Tax ID p: ep Lot No. —
Site Plan Name: %I OO I QI ( i ftZ/i; fR b S C0a,/"1 Block No.
Project Name: I Gh S A P�lP501u - Q� p� Q bCQ
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical
� lectric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
—Gas Piping
_ Sprinklers
Cost of Construction: $ C2�—
Shutters
_ Generator
Windows/Doors _ Pond
Roof Pitch
Sq. Ft. of First Floor: _
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ( 13 {QI IYl `J
Name: O�MA' -w
Address:11(�L1 c -f L_Y,&J2e
Company:_TN 4TI� b1CW �f?P?PT L
City: �_ I - WiilQ. State:-
Zip Code: 3L[gS5 Fax: i7a--a10-,MIR/
Phone No. 1) J - ar1O -'(D R)
Address:--ICR() Ct y 1, \0 (C )CA Y S Clhk (P
City: C�1� State:+CC,
Zip Code: Fax:—n7 gI__J'1 y
Phone No - - Qr1 Ci—(0 ( (7D
E-Mail: M P-CL U L iSaI P fhpLJ aetL5—
Fill in fee simple Title Holder on next page'( if different
from the Owner listed above)
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State or County License Er— (3�0 "i M
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.