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Permit F,:- \,# n
Job Address: _ _ _ phi o 2 i c, n, q
Description of Worn: e r is �,c Ay C
Historic District: Zoah Value of Work:
Footage
Permit Type: Building Electrical _ Mechanical Plumbing Fire SprinlJedAlarm Pool
Electrical: New Service — # of AMPS J OC Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Noa Residential Replacement Newer (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial # of Fixtures # of Water & Sc%vcr Lincs # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial,_ Industrial
Construction Type: # of Stories: # of IhveIImg Unita Flood Zone. r (nm form required)
Owners Name & Address r -e C �c % �, _ cc m /7� ✓ �� L r- 4y � �n
Phone: -t u / - 7 1. / -
Cotrtr —Nl ane& Address: • r9. -
Sp7--7--71 Sh to Lionise Nmd m-
n7-� — Gg 7 2 Comiacf Yersoir i�i G k sG %Q ei f i 7 Phony �% T— 3x J
Phone & Fat yG 7 —
Bonding Company: _ /U —
Address:
Mortgage Lender:
Addrnx
ArebitecbSn&err: Pbone:
Address: I=:
Application is hereby made to obtain a permit to do the work and installations as indicate& i certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet standards of ail laws nodaftz construction in this jmisdietica. 1 understand that a separate
permit must be secued for ELEC77JCAL WORD 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 wont will be done in compliance with all applicable laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMAE NCEMENf MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND 7*0 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COA04ENCEMENT
NOTICE: In addition to the requirements of tha 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 taluited from other governmental entitias such as Nwaer lmwanft distriCti, state egmcies, or federal age mics.
Acceptance of permit is verification that I will notify the owner of the property ofthe requirements_ of Lim F /'
Signature of OwnedAgent Date
Print OwnedAgeWs Name
Signature of Notary -State of Florida Date
Owner/Agent is_ Personally Known to Me or
_ Produced ID
APPROVALS: ZONING: UTiL FD:
Special Conditions:
Rev 038006
L�
of Contractor/Agent Date
ha+'d SchvWT -7-
of NotaryState ofFloriVDate
0110"
JO, ANN M. JOHNSON
t * MY COMMISSION # DD 285622
C o XPIRE :March 23,�2Q08
ENG: BLDG: 1