HomeMy WebLinkAboutJackowski AC Permit app pg 1All APPLICABLE •:: MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED
Date: 'fb.t_t~I Pennit Number: _______ _
Building Permit Application ✓ Planning and Development Setvices
Building and Code Regulation DMsian Commercial Residential
2300 Virginia Avenue, Fort Pieru: FL 34982
Phone: {772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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Lot No. ___ _
Site Plan Name: _______________________ _ Block No. __ _
Project Name: ______________________________ _
New Electrical Meter ____ Second Electrical Meter _____ _
I CONSTRUCTION INFORMATION:
A~nal work to be performed under this pennit-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:$ ~at).QO Utilities: Sewer _ Septic Building Height: ___ _
OWNER/l.ESSEE: CONTRACTOR: • '
·,
'
Name lj(YIO{n~ Cfac.kowskj Name: •• ' J_ ,I t'° ~ .1
y
Address: w10 °"Penr"li ~ ~a;::~~1~~~~.1H~ uty:~ Ple/U State: ft,
Zip Code: 54Gl51 Fax: City: ~ :eitrrl.. State: It.
Phone No. 111 ~g3:2. -?0~'2.--Zip Code: Srml Fax: 11.2.-,t,{,-37 2-:J_
E-Mail: Phone No11'l--Llul • '4141
Fill in fee simple Title Holder on next page ( if different E-Mail Dl¥,{t-at! @.~Qf}.-CO.CD
from the Owner listed above) State or County License CACI fl"il~ C,
If value of construction Is 2500 or more, a RECORDED Notice of Commencement Is required.
lfvalueof HAVC is $7,SOOormore, a RECORDED Notice of Commencement is n,qulred.