HomeMy WebLinkAboutHyde AC Change out permit app pg 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 I~ l 2.,\ Permit Number: ______ _
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LC
Planning and Development Services
Building and Code Regulation Division
Building Permit Application /
Commercial_____ Residential ____ _
2300 Virginia Avenue, Fott Pierce Fl 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
PropertyTaxlD#: _______________________ _ Lot No. ___ _
Site Plan Name: _______________________ _ Block No. __ _
Project Name: ______________________________ _
New Electrical Meter ____ Second Electrical Meter _____ _
I CONSTRUCTION INFORMATION:
Ao/'onal 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
Sq. Ft. of First Floor: ________ _ Total Sq. Ft of Construction5 Cost of Construction: $ }00 • (50 Utilities: _ Sewer _ Septic Building Height: ___ _
OWNER/LESSEE:
Name Y\• t'1 0 V\ w
Address: Ssoo (a.6(e..1)(.
City: lt){-b-Pltrce..... state: .ft,,
Zip Code: 3yq5 L Fax:. ______ _
Phone No. 5(p / ~ <D3 ~-q~3t4-
E-Mail: ______________ _
Fill in fee simple Title Holder on next page ( if different
from the Owner 6sted above)
CONTRACTOR:
Name::....M.1£' m~~_rul'>JJJ.L----,-----,---
~~;:e:~~k~~tn~~~ ~~fi~ ;w.
City: n,.f; Piucg_ State: R...
ZipCode: WI Fax:1]:J.-J.l(,tc3137
Phone No111,:L4C.I • '-114-1
E-Mail boyie.rAi! !-'-/WOO. raro
State or County license CACI jl i1-g (q
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.