HomeMy WebLinkAboutKillackey permit app page 1All APPLICABLE INFO MUST BE COMPLETED FOil APPLICATION TO BE ACCEPTED .
Permit Number: Date: "r f/, -JJ --------
-;-· ··a· · -·a
LC
Building Permit Application
Planning and Development Services
Residential Building and u,de Regulation Division Commercial -----------
2300 Virginia Avenue, Fort Piere£ FL 34982
Phone: (772) 462-1553 Fax: (n2) 462-1578
PERMIT APPLICATION FOR: A. e C:
PROPOSED-IMPR()VEMENT LOCATION:
Property Tax ID#: ________________________ _ Lot No .. ___ _
Site Plan Name: ________________________ _ Block No. __ _
Project Name: ________________________________ _
I DETAILEOOESCRIPTION"OFWORK:
New Electrical Meter ____ Second Electrical Meter _____ _
I CONSTRUCTJON INFORMATION:
A~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
Total Sq. Ft of Construction: ______ _ Sq. Ft. of First Floor: _________ _
Cost of Construction~$--'+'-"6'-=fJ=O~-'------Utilities: Sewer _ Septic Building Height: ___ _
OWNER/LESSEE: -CONTRACTOR:
aime I" a a t.J--aa c.e. k.1' lla." k-~y. • • • I ' f--. J
Name: ..
Address: 2,S:. /. 4 S CA,,.~ i '4 S:: ~:;;~~~~~~~~~~ 'City: liL./--{:,int:.,!, State: p:'J.,
Zip Code: 3'-1.9.£.l Fax: City: fult r1t[(!,, State: R.,
Phone No. I,_(,)_ ff.-1,43-~'l ~ Zip Code: ~I Fax: 17.2.-Pllc 31 g-:,._
E-Mail: Phone No 111.--Ltu I• '-1141
Fill in fee simple Title Holder on next page ( if different E-Mail hDyJ.•.fMl e. roo; caro
from the OWner listed above) State or County license Cite I jJ 11 :8 (,
If value of construction is 2500 or more, a RECORDm Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.