HomeMy WebLinkAboutConwell AC Change out permit app pg 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: :> ( 2.-]} U Permit Number: _______ _
Building Permit Application /
Planning and Development Services
Building and Code Regulation Division Commercial _____ Residential __ -___ _
2300 Virginia Avenue, Fort Pierr:e FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578
PERMIT APPLICATION FOR: p,-/c,
PROPOSED IMPROVEMENT LOCATION:
Address: ' (.
Property Tax ID II: Z ~:3-211 -0025 ~ 000
Site Plan Name: _______________________ _
Lot No. ----
Block No. __ _
Project Name: ______________________________ _
I DETAILED DESCRIPTION Of .WORK: ~
New Electrical Meter ____ Second Electrical Meter _____ _
I CONSTRUCTION INFORMATION:
A~nal work to be performed under this permit-check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
Electric _Plumbing _ Sprinklers Generator Roof Pitch ----
Total Sq. Ft of Construction: ______ _ Sq. Ft. of First Floor: ________ _
Cost of Construction: $----'ij='J,.o0 __ .00~----Utilities: _ Sewer _ Septic Building Height: ___ _
OWNER/LESSEE: CONTRACTOR:
Name......s:.,t_4jlt!.ll.ll.l!f,l,-1!!~~!..!lllllL......t:M!.~al.l.,,_,__ Name: ·
~:~ess:'---,~""
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"-'~'--~:...c...::_-'-0---=-.'--'-'-IL""-----Sta_t_e_: \;ie~-~~;~:;ta:t~-tt=)j ~it~ ,k
Zip Code: 33iii.4 Fax:---,-.,------City: Wt PitrC(.. State: R..
PhoneN~: j1~-u33~0l.,g'f . ZipCode: ~( Fax:JJ,-J.U,-3137
E-Mail: PhoneNo11l,--4C,(. l-1141
Fill in fee simple Trtle Holder on next page ( if different E-Mail bo'J{1.c:tel @, '-(4,hoo. l'IJ(Yl
from the Owner listed above) State or County License CACI jl ~I '8 (,
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.