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� Building Department <br /> , TpfV iGA <br /> Date Received Phone.¢ontac�f,or Pe Ittin �3 '� — -�9 65 <br /> Owner's Name � ���M � Owner Phone Numba `��3-�g3- Z�39 <br /> � <br /> Owner's Addr�ss 3 SSa z �e n/R �R Owner Phone Numbe <br /> Fee Simple Titl eholder Name Owner Phone Numbe <br /> � <br /> Fee Slmple Tltlehoider Address <br /> JOBADDRE33 �gg�� �� `( PQ �P�'�Y��115 FL 33S�1z LOT# � 6 <br /> SUBDIVISION; V R2K �'�'1�� PARCEL ID# ��'�'.Z�'dl$0 -Q OOO � lJ/6� <br /> (OBTAIHED FROM PR PERTY TAX NOTICE) <br /> WORK.PROPOSED B NEW ONSTR B ADD/RLT � SION Q Q DEMOLISH <br /> � INST LL REPAIR <br /> PROP03ED USE Q SFR Q COMM � OTHER <br /> TYPE OF CON8TRUCTION Q BLO K Q FRAME [� STEEL Q <br /> DESCRIPTIONI OF WORK AL2 K/�L 'Y' Sr <br /> '�Sr'ie, FL .Z 6 q. 3 <br /> ; <br /> BUILDIN(i SIZE SQ FOOTAOE� HEIOHT <br /> OBUILpINO $ VALUATION OF TOTAL CONSTRUCTION <br /> � � 6 $ <br /> QELEC7RICAL $ AMP S�RVICE Q PROO ESS ENERC3Y Q W.R.E.C, <br /> OPLUMBINO $ <br /> I (� <br /> C]MECHANICAL $ VALUATION-OF MECHANICAL INSTALLATION � �?� [ � <br /> �]OASi Q ROO ING Q SPECIALTY � OTHER Z ��� <br /> =1NISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO � <br /> G C�F�.�l �--.'Z" <br /> � � <br /> 3UILDER q-�� �� � / �� COMPANY L ow•eS NoMe, CeN'T�2s � L� <br /> 51GNATURE v���.�• REGISTERED �Y7, N FE CURRE� Y/N <br /> Address � �O 1� � O ��J 2�A��'" 3�"��� Licens # ��o .S(� 1 <br /> =L.ECTRICIAN, COMPANY <br /> 31GNATURE RE013TERED Y/ N FE CURRE� Y/N <br /> Address Llcens # <br /> �LUMBER � COMPANY <br /> 31GNATURE � REOISTERED Y/ N FE CURRE� Y/N <br /> Address Licens # � <br /> MECHANICAL; COMPANY <br /> 31GNATURE REGISTERED Y/ N FE CURRE� Y!N <br /> Addres� , Licens # <br /> 7THER COMPANY <br /> 31t3NATURE ' REOISTERED Y/ N FE CURRE� Y/N <br /> Addreas I Ltcens # <br /> 2ESIDENTIAL Attach(2)Piot Plans;(2)sets f Bu.ilding Plans;(1)set of Energy Forms;R-O-W Pennit for ew construction, <br /> MlnlmuM ten(10)worfcing day after submittal date. Requlred onsite,Constructlon Plans, tormwater Plans w/Sllt Fence Installed, <br /> ---— - - � Sanitary,FaclllUes 8 1_dumpst r,Site Worfc Permlt;for subdlvlsionsflarge proJects _ <br /> :OMMERCIAI Attach(3)complete.sets of Bu Iding Plans pius a Llfe Safety Page;(1)set oi'ene�gy Forma:R=0=1h'PeRnit-ioc�nev�-constructl�n.� ---- <br /> Minlmum ten(10)working day after submlttal date. Requlred onsite,Constructlon Plans, toRnwater Plans uv/Sllt Fence installed, <br /> Sanitary Facllltles�1 dumpst r.Site Work Permit�for all new proJects.All commerclal requi ements must meet compllance <br /> 31GN PERMIT , Attach(2)sets of Engineered lans. <br /> '""PROPERTY SURVEY req Ired for all NEW construction. <br /> )irections: <br /> Ffll out appllcatlon completely. <br /> Owner&Contractor sign back of appllcation, otarized <br /> If over 52500,a Notice of Commencement s required. (AIC upgrades over 57500) <br /> ' Agent(for the contractor)or Power of Attome (for the ovmer)would be someone wlth noterized letter fro owner euthorizing same <br /> )VER THE COUNTER PERMITTIN(3 (Front of ApplicaUon Only} <br /> Zeroofs If shingl;es Sewers Service Up rades A!C Fences(PIoUSurvey/Footage) <br /> Drlveways�Not over Counter If on public roa ys..needs ROW <br /> � <br />