HomeMy WebLinkAboutMurphy AC Change out permit app pg 1.pdfAll A~ INFO MUST BE COMPI.ETED FOR APPLICATION TO BE ACCEPlfu
Date: 2.L~/% Permit Number: ______ _
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Planning and Develapment Services
Building and Code Regulation Division Commercial ____ _
Building Permit Application Residential_..:,✓~---
2300 Virginia Awmue, Fart Pierce Fl 34982
Phone: 17n) 462-1553 Fax: (n2) 462-1578 CBDG Funding ___ _
PERMIT APPLICATION FOR:
Address:-l!....LL..J.---><:J.a.L...JLL!,O:'.LLAe.__;::....:.;1-..,.._,_,.~-'r-'-"'-'=-"'---'-..L..=--\-!,,IU<WLL"-'-.!..W.-"""C--..:......:~-
Property Tax ID#: ....:'J,,:...<:""-"''--..:::::;__.u...--=~----=-----=---=-=,r-:5="-----------
Site Plan Name: ______________________ _ Block No. __ _
Project Name: _____________________________ _
I DETAILED DESCRIPTION Of WQ8K: . . f
New Electrical Meter ____ Second Electrical Meter _____ (Affidavit required)
I CONSTRUCTION INFORMATION:
Additjonal work to be performed under this permit -check aU that apply:
{ Mechanical A/t _ Gas Tank _ Gas Piping _ Shutters
Electric _Plumbing _Sprinklers _Generator
_Windows/Doors
Roof
Pond
____ Pitch
Total Sq. Ftof Construction: ______ _ Sq. Ft. of First Floor: ________ _
Cost of Construction:$ tsJ..1-<JO. OQ Utifrties: _Sewer _ Septic Building Height: ___ _
OWNER/l.ESSEE: COffl'RACTOR:
Name S '
Address: C!Q St"
City:}1}(Yl!YJKL0 f;Rac.b State: R-Address:...,=i=_.p._4"''1LL¥""""--r.ua=_:_:'---
Zip Code: r ~j_{) fuq Fax:~-----City: 00::: Pw State:
Phone No.ft0oi[: Mirt_ ,My,q>m1 E-Zip Code: .3tl't) I Fax: _____ _
Mail: H:fo .S -9 lo 9'8 Phone No 1:1 )--4C. 1-4-t 4-1
RII in fee simple Title Holder on next page (if different E-Mail \,o~lt.~½f4.b,¢. C,6)T\
from the Owaer listed above) State or eoudty license C.Al I g C/U X ft
If value of construc:tion is 2500 or mon,, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or man,, a RECORDED Notice of Commet1e.ement is required.