HomeMy WebLinkAboutBuilding permit app.All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �illq Permit Number.
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Building Permit Application
Planning add cevelopment5ervia5
Building and cone Reguknon Division Commercial Residentiali
2300 Virginia Avenue, Fort PNra FL 34982
Phone. (772)462-1553 Fax: p721462-1578
PERMIT APPLICATION FOR:
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PROPOSED IMPROVEMENT LOCATIO
Address:
Property Tax lO p'. Lot No,
Site Plan Name: Block No.
[DETAILED IDESCRAl- --_ y
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New Electrical Meter Second Electrical meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Sbuli -I, Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sri Ft. of First Floor:
Cost of Comtructiorm S 2 I SS Utilities: Sewer Septic Building Height.
OWNER/LESSEE:
CONTRACTOR:
Name NIFNMI ropy to
Name: SCUP
S-via
Address:) UbZ, Nu/ V L M. Fri
Company:
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City
Zip Ce: Fax.
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Phone No (2^ ) Sap- S'3ob
Address: 9AH' /):rdo, RL.r/
Ciry: O✓L t.....2 Luca State:x
Lp Code:.3gpre&) ' Fax:
Phone Nd7-?ZI 1;�;; g- Dire I
E-Mail:
Fill In fee simple Thle Holder on next Page (if different
from the Owner listed above)
E-MailO nn//iw.
Stateor CounMuwse Z83�
required.
If Yalu of HAVC IsSLSW or more, a RECORDED notice of Commencement 15 recall