HomeMy WebLinkAboutBergeron AC Change out permit app pg 1.pdfAll APPLICABl£ INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPI w
Date: 2-{ L/-I Z-'2-Permit Number: ____ _
(:.:. ....; _.· ' ~' ... ·----._ ~ . ' '. --
[!' Building Permit Application
Planning and Dellf!lopment Servia!s
Building and CDde Regulation DMsion Commercial ----Residential ___ L.,___
2300 Virginia Aw,nue, Fart Pien:e FL 34982
Phone: (m) 462-1553 Fax: (ml 462-1578 CBDG Funding ___ _
PERMIT APPLICATION FOR: A (!.,. CM.n -DI.ht
PROPOSEDIMPROVEMENTUXAllON:
5 e_,, rl..-Address: _ _Y<.~""0'--'-.(A...J.1-.'14--'-----'---'=-''-"'--V-+-.J-"1.w..---,µ...,:c__=L...!.:::::...!.---i,,;+:.-~-'--"':::::_;:___....,.,..__,.._,
Property Tax ID#: _____________________ _
Site Plan Name: _____________________ _ BlockNo. __
Project Name: ____________________________ _
I DETAILED DESCRIPTION OF WORK: -•
tlh foe /Jilt: JMSfJ< l/ .3 5 :tvn &WLD t4 S€E-f. A [6
New Electrical Meter ____ Second Electrical Meter _____ (Affidavit required)
I CONSTRUCTION IHFORMAllON:
Add~nal wor1c to be performed under this permit -check aU that apply:
~Mechanical ft/C, _ Gas Tank _ Gas Piping _ Shutters Windows/Doors Pond
Electric _Plumbing _ Sprinklers Generator Roof ____ Pitch
Total Sq. Ft of Construction: ______ _ Sq. Ft. of First Floor: ________ _
CostofConstruction:$ 5LJOQ. 00 Utilities: _Sewer _Septic Building Height: ___ _
OWNER/1..ESSEE: CONTftACfOR:
Name,_\Sl'.,.,Ll.[l!M~!:......~~IJ:.d.!l!'..V')..!_____ Name:
Address:"'-"''--15-(4.o!--'-'i&..u"'-ld.L--------Company:.D!'lllJ.l<...J!'.l{-.1.L.~nD~~,.J!:!~:..• _
City: 11l{¾j?1tf[L-State:fl..-Address:-"""'"""-µ._......,LLLl<>no'-L-<UO=--'--"--•-
Zip Code: 3~51 Fax:-,------Crty: (,fl;'1: Piure State:
Phone No. '6 / 3 ~ 3'E0 _ q £t & Lf E-Z-ip Code: ,3!J't5 I Fax:
Mail: Phone No1:1,-.-4C.1->f-t4 I ------
Fill in fee simple Title Holdel' on next page ftf different E-Mail 'oo~~ ~f4ii@-C6)'t'
fromtheOwnerlistedabove) StateorCoultylicense C.Atl&{l\lX [,
If value of COIISlnldion is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,SOOar-, a RECORDED Nlllkeof Comlno!RCeme.it is required.