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HomeMy WebLinkAboutLYMAN 1All APPLICABLE 1N�D �IIIL�ST BE G�1111PlETED FAR APPlICAiIDN T� SE AC�ERTEI�
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`� �`����� Building Permit Application
Planning ❑nd Development 5ervrc�s
Suild�ng and Cody Regulation Diuisian
�3pn Virginia Rvenue, For#' Arerce FL 3�982
Phone: 4772) 462-�5�� Fax: �77Z} 462-�57�
Commercial Res�der�tia� V
PERMIT APPLICATION FOR: ELECTRICf1L
PROPOSED IMPROVEMENT LOCATION:
Address: Ib85'S` �iENR`I�`5 �D .
Property Tax ID #:
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_�aai- 5o i-�o�.�000 - ► got �o.
DETAILED DESCRIPTION OF WORK:
�s-r�,L� C�r����n �ro UN —� G�:LtN� �a.1d�SK
�Ml��IG `-!'2A�ISFF�4��TCFt P�N,D C�I'� �T02 T�(STI�tL
M�T� � c,�N �v � c��a�t �� � � 5�s-r�
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Addi�iona! work to
be performed ��dcr
this permit - �h�ck
a!I that apply:
�M�chanical
� Gas Task
T Gas Piping
� Shut�e�-s
Ele�'�ric
_ Plumbing
Tvta! Sq, Ft of Cvnstructiv�:
Cosh of �Qnstr�ctFor�: $ ------ J' ��,�'�] .fib
Sprinicler�
lltlindows/Dvvr�
Block No.
. Tt�ST¢iLL
Pond
Generator Raof Pitch
Sq. Ft, of First �Iva�:
Utilities: ,� Sewer � Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name F(2d�ICIciL �NMOcN �
Name: � E,
Address: 1(�$SS- l�eYlv�S �Ci.
Company: Na-4u�
Ct
city: V=k. Aeres� state: �
�
Address: 1A1D-1w� iciWQU
Zip Code: c�H� Fax:
City: �', P�P�esv
state:)
Phone No. Y1''1a-y (off- 15'13
zip�ode: 3'-Igga--
Fax:
E-Mail:
Phone No �►7a-+Cat-
83a�
Fill in fee simple TRIe Holder on next page (if different
E-Mail �,(�YY1et IY1L1i-�.�e�.dQO
�
� • C�9'Yl
from the Owner listed above)
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State o Cr ounty Eicense
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