HomeMy WebLinkAbout820 W 25 St 03-2778 HVACHistoric District: Zoning: Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm PoQI" .
Electrical: New Service — # of AMPS Addition/Alteration 00-6 Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & ]Energy Cali. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair— Residential or Commercial ¢"
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Tyne: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: Attach Proof of Ownershipp & Legal Description)
Owners Name & Address: I, _`
L Phone: T40
Contractor Name & Address:
State License Number: Lip C0,34F.-W _w
Phone & Fax:7 5-3- 3" % Contact Person: Phone:
Bonding Company:
Address:
Mortgage Lender:
Address-
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has comnienced prior to the
issuance of a permit and that all work will be pefomred to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable lav,= ref ulating
construction and zoning. WARNING TO OWNER YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR_ tAI.--'ING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of
this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I null notify the owner of the property of the requirements of Florida Up ., FS 713.
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Signature of Owner/Agent Date Signature of Contractor/Agent Date
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Owner/Agent is Personally KnoYrn to Ilvte or Conta: ctor/A-: is Personail_ Known to Me or
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PPLICA I ION APPROVED BY: Bldg: Zoning: L;::: es: FD:
Initial & Date) (Initial & Date) (Initial n Date) (Itrtial & Da:;
Special. Conditions: