HomeMy WebLinkAboutBuilding permit app, pg 1All APPUCABl.E F, MUSr DE COMPlETED FOR APPLICATION TO BE ALCEPIED
~~~M ~~N~r: ______ _
Building Permit Application
PlanninganaDew,lopment~
Building ana Code Regulation Division Commercial ___ _ Residential ____ _
2300 V-llflinia A_,.,, Fart Piem, Ft 34982
Phone: (772) 462-1553 Fax.: {772) 462-1578 CBDG Funding ___ _
PERMIT APPLICATION FOR: A (!,,. Chan _ ol);.t:
Address:
lot No •. ___ _
Site Plan Name: _____________________ _ BlockNo. __
Project Name: ____________________________ _
I DETAIUl>'~OF ~ . •.. . ....
UYJ Joe Ufi, ~ :A1stmi &uu> .s-to" , 4 sG6~ -Ale Pui t.u:itJ--'-'l-lh to /<U) htak.
New Electrical Meter ____ Second Electrical Meter, _____ (Affidavit required)
I CONSTRUCJIOfttNFORMAllON: .• . .
Add~nal wor1< to be performed under this permit-check all that apply:
~Mechanical Afe_ _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:$ ~ g 00.@ Utilities: _Sewer _Septic Building Height: __ _
Mail:. _____ ~:::<.......!U~_!.!,!=----
Fill in fee simple Tdle Halder an next page rlf diif&l!llt
from the Ownerlisted --·
If value vf c:unsbuc:lioll Is ZSGOor-. a R£COIIOED Notice af CL •• •• "'n,quired.
If value of HAVC Is $7,SOOar.._ a REtoRDED Notice of Cmm&i!lb.el-lsrequlred.
I