HomeMy WebLinkAboutShiflet AC Change out permit app pg 1All A~ 11~ MUST BE COMPLETED FOR APPUCATION TO BE ACC£PrED
Oate:4 /J'b Permit Number. ______ _
S:'l: LUCU!.s -----. . .. . ' -: :r :,Ji I -,.
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Planning and Development Services
Building and Code Ri,gulation Division
Building Permit Application /
Commercial_____ Residential----''---
2300 Virginia A""'ue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: {772} 462-1578 CBDG Funding ___ _
PERMIT APPLICA 110N FOR: A c.. Ch4.n _ oc.,t;t-
('or//J Address: _\O__!LlJ.P._...J;ifil/..W~,._i.Z1..:-..,_--t:1./tLI~vd..k_ lt-!ec..,___.:2lt;j...2..L.µ:~~~~~,__r_~~~
PropertyTaxlD#: ______________________ _ Lot No .. ___ _
Site Plan Name: ______________________ _ Block No. __ _
Project Name: _____________________________ _
DETAll.£0 DESCRIPTION OF WORK:
New Electrical Meter ____ Second Electrical Meter ______ (Affidavit required)
I CONSTRUCTIOM INFORMATIOrf:
Ad✓.'.nal work to be performed under this permit -check aU that apply:
_Mechanical Aft _GasTank _Gas Piping _Shutters
Electric _Plumbing _ Sprinklers Generator
Windows/Doors
Roof ----
Pond
Pitch
Total Sq. Ftof Construction: ______ _ Sq. Ft. of First Floor: ________ _
Cost of Construction:$ .5350. 00 Utifrties: _ Sewer _ Septic Building Height: ___ _
OWNER/t.ESSEE: CON'.fRACTOR:
Name: Name____::,u,c::u,""---c,......'-l--1'1'-Y"""-''-------
Address:..,._,~"'--'"""''-"'-'=~4-------,..,--
City: fo(/;: Pilt(f, State:,& Address: ...sao~1-J"""1.l.l..¥!J"""-..r;u~~=-•:....._
Zip Code: .3~ 5 I Fax:______ City: (-:Oft;-: Pi'trU State:
Phone No. 115 -443 ~q (e I 4: E-Zip Code: 3ll't5 l Fax: _____ _
Mail: Phone No11,--4C.1-414-1
FillinfeesimpleTltleHolderonnextpage(ifdifferent E-Mail loo~~f,ill@. C&}T'
fromtheOWnerHsted above} StateorCoudtvlicense COCf&llHX ft
If value of c:onsttuclion is2500 «-•a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or-, a R£CORDa) Notice of Cotn.nencen,e.,t is required.