HomeMy WebLinkAboutJohnson AC Change out permit app pg 1Date: ~ jl-1 Permit Number:
AU.APPl.lij IN~ MUST BE C0MPI.ETED FOR APPLICATION TO BE ACCEPTED
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Planning and Development Services
Building and Code Regulation Division
Building Permit Application
23()() V-wginia Avenue, fart Pierce FL 34982
Phone: {772) 462-1553 Fax: (7n) 462-1578 Commercial ----Residential ----
PERMff APPLICATION FOR:. To Select from dropbox, click arrow at the end of line '~~,----lftffi:.••··<•. '~~~~---,..-,.--,..-,.~-,-,-c,,----..,....,-,----lll
Address: 5203 I:;. €dao Pi'nes r. ,tf)(-/-; R'trce,. 3LJ,qs(
Legal Description: -HQ l~ '.Yt'r'l,Q,S 5/C> niak JC tllr 3't.5
PropertyTaxl0#: l.3/l-~~-Ol48 ~ooo-4-Lot No. ___ _
Site Plan Name: _____________________ _ Block No. --
Project Name: ____________________________ _
Setbacks Front~--Sack: ___ Right Side: ___ Left Side: __ _
LJ[cp. for Ula: ~~! s. s--tvn ts .see~
A{C. s1stM111 utrtn 10 f<a.J rie~
Gas Tank as Piping
D Plumbing Osprinklers
Shutters
□Generator
0 Windows/Doors
□Roof
Total Sq. Ft of Construction:~-----
Cost of Construction: $ 5, @!) , QQ
I
~ of First Floor:
Utilities: LJSewer □Septic Building Height: ___ _
OWNER/1.,ESSEE:
'·, . '"'
Name__f;.)'.µtUJ~,..dOt.U1.:~L---.rc,------
Address: 5,H?3 ~-Ilho Pines 'r.
City: fort:Pltrce,... State: t<..,
ZipCode: 5ll'l6/ Fax:. ______ _
Phone No. J..~ ... q(gl~ ~--pfo
E-Mail:. _____________ _
Fill in fee simple Ttde Holde.-on next page { If diffet ent
from the OWner listed above)·
Name: ~~=Y_;_i,"!:C/~,----.-:-;-----:-:----::;::-
Company:
Address:5~(~{)~ftLJ@f,'!KJk.!M;~:.fi:&,_--=.._
City: n,(1:, 'if(.R_,;
apCode: -3495! Fax:"71:Z.·'-t{,/e-3151
Phone No. J1:!-__,4<.,.o_.._f -_4~1~4::._!..__ ____ _
E-Mail:boy/eal\P\k!hoo. Co £!1
State or Coimty t.icerJe: CA<!, 11! I -g I a t,
If value of__, Is $2500or-, a RECORDED Notice of Commencement Is required.