HomeMy WebLinkAboutBuilding Permit Application Alf APPl1C_A t E INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Planning'andDevelopment Services'
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Building-and Code Regulatlan Division COC11R1E?1'Cl2l y � - , R25[dErltlal
2300 Virginia Avenue,Fort FL 34982
Phone:(712)462-3553 Fax:(772)462-1578 `
PERMITAPP;LICATION FOR:
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Address: !`�l n, �,r
Property TaxlD'#: `t'v{�
. Lot No.
Site Plan'Name: Block No..
Project.NameCC' :, iPll .
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-41
1D1LW
New Electrical Meter Second.Electrical Meter
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Addit!onal'work to be performed under this permit check all that apply:
Mechanical Gas Tank Gas Piping _Shutters Windows/Doors . P`
Electric _Pliknbing '5p'Ihklers: ;Generator Roof Pitch
Total Sq.Ft of Construction: Sq.Ft. of First Floor: .
Cost of Construction:$ 4 I . ; <_ Utilities: Sewer Septic Buiiding-Height•..
01&UN ER�SSi1: 4Cf3�1
*Name•.
Address s `t. '� LOn e_ rCiornpany s^
` ._ State:
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City,, fate Adclres�s uyti) : �'i
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Zip Code' Fax: City: ��,� Stater Phone Nb.' Zlp Code: ,�� v 7 ^§ Fax:
E-Mail: Phone No?`-?_'n2= -~
Flit in fee simple Title Holder an next page:(!f different E-Mai)-t{-Cs `V C'c�,l L Lt',
from the Owner listed above) State or County Litense
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.
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