HomeMy WebLinkAboutBuilding permit app pg 1Planning and Development Servia!s
Building and Code Regulrman DiVision Commercial ___ _
Building Permit Application
Residential __ / __ _
2300 Virginia Awmue, Fart Piera! Fl 34982
Phone: (7n) 462-1553 Fax: (772) 462-1578 CBDG Funding ___ _
PERMIT APPLICATION FOR: e,. CMn -oLtt-
PROPOSED tMPROVEMENT LOCATION:
PropertyTaxlD#: _____________________ _ lotNo.~--
Site Plan Name: _____________________ _ Block No. __ _
Project Name: ____________________________ _
I DETAILED DESCRIPTION OF WORK: . .
New Electrical Meter ____ Second Electrical Meter _____ (Affidavit required)
I CONSTRUCTION INfORMATION:
Additj<>nal work to be perfunned under this permit-check au that apply:
~Mechanical A/l _ 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 Construct.ion: $ 4,q 15 . 0 0 Utilities: _Sewer _~ptic Buildi~Height: ___ _
OWNER/LESSEE: CONTRACTOR:
Name e,_. Name:
Address:qo Ill S1"' Company:~Uff......,D..t--'-'--~lll.1~7:\-r':;;!-'f--'---
City: J1)M pa}JO WCh State: Fi-Address: -"<llt=..,o......U0<1JU-¥"""'-_,:;cao=:,__:_.,:;..:_'_
Zip Code: 3c,O<a1 Fax:_______ City:~ f/Uu State:
PhoneNo.-:lertMl:h YfllYl~Sold@o E-ZipCode: .3'851 Fax: _____ _
Mail: 1J;l,,-3(8•JiJ(d PhoneNo1:1::l--4<,t->f-t41
Fill in fee simple Title Holder on next page flf different E-Mail \9o ~OU!, ½j4.h@. ~
from the Owner listed above) State or c.oudty license C.Al I& OU X f,
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or mare, a RECORDED Notice of COIIARHceme.Jt is requited.