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' ' �- � ; Build�ng Depattment ,
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<br /> pate Receive,d t , ' ' ' �hone Contact for Permitting � •.� *�- •`
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<br /> Owner's Name � � .// . � Ciwner Phone�Ntimber �/.l"`j.Z�` ��/��
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<br /> Owner's Address . /,�1�2¢i'l/ t�'t.°.! ' Uuirner Phone t+lum�ei� .
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<br /> � Fee Simple�Titleholder Name I• � ' i ' Owner Ptione Num6er
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<br /> Eee SInnpleTiUeholder Addr ss"'' ( ' -. �• . • -
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<br /> • J08 ApDRESS f� 8~�'S� l'i Pc�i,�?v� l�lvr�. ' LOT�� �� .
<br /> SUBDIViSIDN.� • � , � ' �� � P'ARCEL @# G of't�it-ai'�� '
<br /> , . • ' : . ' • •-I -(OBTAINED FROM PROP 7AX NOTIG� �
<br /> WdRKPRtaFOSED ' , ';. NEWCON57R 'Al7D/Al.T SIGN MOVE �[� UEMOLISH . .
<br /> . • ' I INSTALL ' � ..RE IAIR� • • � •
<br /> PROPOSED USE # S�Ft , �- GaMM Q OTHER ' •
<br /> � • TYPE t�F C01USTRUCTI�1N � BLOCK Q, FRAME' .C[ � STEEL Q QTHER •
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<br /> DESCRIPTIOiV OF WORK. • � . I ,)!('� " L-� r✓ri27J.�'D� .
<br /> BU1LQlNC SIZE. " • � SR FOt?TAGE � i' � � H�IGHT ���
<br /> ' [�] 6UILDING $..> i� VALUATION O�TOTAL COIVSTRUCTION . �j�"•r�,�p�`
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<br /> Q 'ELECTRICAL $ • '_ ' . AMP SER�/ICE � Pi2t3GRESS�ENEt26Y Q W.R,E.C.
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<br /> [� �Ltl(VIBINC � ���. .. � . � � 1'��t,,c1
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<br /> Q MEGNA�IiGAt, $. , � + . . .. VqU1AT10N.DF MEGHAPtlCAL INST�ILlATlQN ��r��� � �
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<br /> � � GAS r, [� �, Rf3QF13�lG- ,� . SPEGIP►lTY � `07"HE}�' • , Cf�r��-�/�
<br /> FINISiiEt7 F�OOF2 ELEVA'f ONS � . - . FLOOD ZONE AREA . �YES` � �QIV�Q,.%`
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<br /> , BiI1Lt}ER ' . � -' j �,. , �._f COMPANY ' . ... - . : �t�r�f5'.
<br /> Si6NATURE • Gr�� ' � �q � ; . 1�7 L�P_i'' ..
<br /> , , RE��sr��a Y! N .. ��cuR�rn': .Y�/N
<br /> � Address �t 7'a, FL .3'3L3y - " . . Ltcense� �� ,��Q&7g� �
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<br /> ��.��cn:ic�u." . � . �,°'rcaM�A[�Y -� .
<br /> SlGNATI�lRE ` � �'' • ; �r�s�En . .' .Y/ N '-F�cut�Ertr - Y/N '
<br /> � Adiires� - ` , , , , . • License# �� �—�
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<br /> PLUMBER '' _ . � . �� . , CAMPANY .. � • .
<br /> � SIGNATURE• � i REGISI'EREO Y/ N FEE CURFiENT ' �Y I ht
<br /> . Address � ' . . �, i • `'' . . 'LlGeASe# �� � �
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<br /> MECWI�NICAL � - ' � � , � '_ ' � COMPANY �� -
<br /> • SIGNATURE - ' � � REGtsI'�REq Y/ �1 . FEE CURREN3' ' Y J N . . .
<br /> . Address � ' ' ' ` � ��� ��
<br /> - • • ' ' . .License#
<br /> '—' OTHER' ; ._.. ..�..___._._.�.__ - .. . i . . . - . .
<br /> SI�NA'i't�ttE � '. �.'. � � ! ��ts��o ' Y/ t� �cu�r N � -- .
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<br /> Address ' j ` • (.iaen'se# .�u �� �
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<br /> RESiDEHT1AL At#ac}�(2}P1a Plans;(2)sefs of Building Pians;(9)set af�ttergy Fatms;R-0-W�Permi#for neinr coasttucUot�,
<br /> , . °Minir�um,ten. ,Q}warking,clays after su6mittal date.� Required anslte,Constructinn Plans.Stormwater Plans w%Sil1 Fence installed,
<br /> �, � Saai' ry:Eacili es 8�1.d' g P. 1
<br /> �,a ur�pste'r,Site Work Periiilit fior subclivisicinsflar e ro eafs-
<br /> COMNiE12C1A! . ,AttacFi.(3)co plete sefs af 8uitdiog Pians plus a Liie SaFe[jr Page;.(1)set•of�nergy For�xis_[3-i0r-W 1'ecm[f for,new constructlon.
<br /> � . �Mlnii�sum ten +70)working day's aftersUdmiltat dateq RequPred o�isite,ConstrucGon Plans,Stormwater Plans w/"S(It FenCe•insfaUed,
<br /> SaN ry Facil 'es&1 dumpster.Site Work Permit for all new projects.AU commerciat requirements mUSt meet�ompliance
<br /> ' Si�N PERMiT Atfa�h(2}set�of Engineered Plans. - __ --. � - - - --- ---- ___ . _.
<br /> . "","'P�FtOPER`fY SU[�VEY required fpr al1-NEtG46:�onstruction. � - � ' - -
<br /> Dtrect�dns: ' . � . , . . .
<br /> 1=i!!out applicaUon cosnpletely. � .. ' • � - .
<br /> Owner&Co�tractar ign b�ck�of applicaiion,notarized ' � • '
<br /> If ave�$2�00,a Not��e of Co�mencemenf is required. (AIC upgrades aver�50dd) � ' '
<br /> ** Agent(for fhe conha�tor)o�P�wer of Attorr�ey(for the ovuner)wouid be someone with notarized letter from owner autharizing same -
<br /> OVER l ME GOUN7'ER PERMi7Ti (3 (Fror�t o�Application�nty) , -
<br /> .ftesaafs 5ewers Se�,rlce.Upgrades AtC Fences(Pto#/Sesrvey/�ootage} - .
<br /> DriveWays-Not over�ounter f op pubiic roadways.:needs ROVN � � ' � �
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