HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONi
Plndmea & Dmlop>o fts sosv m
Building & Code Regolatl6w DMdoo
2390 Vk%h a Ave.
>abrt Flom FL. 3490
(T'i��ib3.9
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing $ HYAC 17 Fence
0 grad CI Demaltilien C! Gasp O siding
Seepyic �, J�rinmenmElm � P�'� ��� �pedaE[v pwmrn
Z. parcel W Nwnberi l ���1 — —0 1 b,) -- O'DO
��C4 «SP
r�
i�LYQM
T.w,Yp �e
Mop ra.
Zug
Un
Only
3. Complete Nworiptim etpMou or wart:
3NV%q,1"nClL-k-
4. Ownere Irrnfarmation I Caatrnoiws Idbrmattae
Nemec L. w" - w. 6-: r`
Addrnw: i' f o % S - OLe-ah D r. Lb t '? W
Cityc .� ! &,.. &e sleta:
Zip:
6. volue orCoostrue*n: 9 :Woo, w
OWNEA•e A"IDA"r.
vdth dl gpliwblo lawn
PRINT OWM OR WNTRACTORFAMB
C,A Co 56q-4
cuty cerms _ l 05
Sadlaeal NamO: �w6lA, V'
oe:�7�-t1�1� 131 Foy
WI , L1C
STATEOFFLOM&COUNTYQF 11 � l
ACYN0WLEC090Jq$N0R6MBTWS OAYOr Dcgk6y -zn l py� l�a.�/�+ �ri 1,*"1--J 4
WHO 1S PO4SONALL'Y KNOWN TO MB _ OR WM IIAg p+RODU=
AS IAFNTIF1CATXM.
MMIUNWALTM
OffTQA7'tlRR OF ARY TYl1<PJC11V7' NAMQ OTARY * Mir �jI9�lON 1 EE W17i1t
COMhtt&WN Nubmat EXPIRM Mey 14, 2017
+�,�,�a�' ea�amN a�,l Naryen►k�
Nona TO OwlVlm. FAILUM 7+0 RZMRb A P Ur= OT COS MAT IROws W TOM IPM I'10 TwlCE FOR
1M MOVls[ Mwn TO YOER rxwNVTY, 0 M VnWD TO DWAIN )WANCRda, CONl t J&,T WEM x0WR
x.6P1M OR AN A7T larmY o1mn uCQ0l ma yoUR f10 ncz OF commNC6lb>iiNT.
1! 7L>rigPl': &T-M ATR1cPI�W16=a UM COWMA" UNI1R1{ Ir7MA
lA-W e4126010
ti000i an-rnuaciAuninua�knWWAnua iraiian7]ii uu., ,rn•oi fiin7/071ni