HomeMy WebLinkAboutWelch ac change out permit app pg 1 All APPLICABLE INFO MUST BE COMPLETED FOR APPIICATH1 TO BE QED
3 Date: Permit Number.
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= J` Building Permit Application
Planning and Development Services /
Building and Cade Regulation Division Commercial Residential y
23W Virginia Avenue,Fart PierEe FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: a�-
PROPOSED IMPROVEMENT LOCATION:
Address: qqs v ro ¢art ` '3�1- 2.
Property Tax 1D#: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DEWRIVnON OF WORK:
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New Electrical Meter Second Fk4ctrical Meter (Affidavit required)
CONSTRUCnON INFORMATION
Addit' nal work to be performed under this permit—check all that apply-
-mechanical Nt _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:$ Oo.00 Utilities. —Sewer Septic Building Height_
OWNERAESSEE: CONTRACTS :
Name Name:
Address: 4L('8 PAAMnAllh Company: &VIL leax�
City; State:
Address: j lr
Zip Code: a a`- Fax: City:6dL IFIWU State:
Phone No.� E- Zip Code: 1 Fax:
Mail, Phone No-rr 3-- AW1-*t`k t _.__--
Fill in fee simple Titer HoMw on next page(if d'ifkgent E-Mail 0 f&OL%N . CSY^
from the Owner fisted afire) State or Cou ty License
If value of coon is Z5E10 or more,a RECDRDED Notice of Commencement is required.
1f value of HAVC is$7,500 or more,a RECORDED Natice of Commencement Is required.