HomeMy WebLinkAbout449 S Elliot Ave:.i
�� 77
,.. .:.
-: ='Y- 0F,3AtNVOIRD PERMIT APPLICATION
Permit # : U Date:
Job Address: Jug aPA L), 3a-721
Description of Work: 9k4wL fico M F'C 6 P'5E R6 'p_�D P'v 141fkel'rognsz
Historic District: zoning: Vnitic of Work: S -OD
Permit Type: Building Fslcctrical Mechanical Plumbing Firc SpririUcr/Alarm Pool
Electrical: New Service - # of AMPS Addition/Altcratio�_ Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replaoemcnt Ncw (Duct Layout & Encrgy Calc. Acquired)
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 )k— Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone; (FEMA forttt regntred for rpther than X)
�y
Parcel o, J b" ! 3I Jc} S^' ( (Attach Proof of Ownership & Legal Desertptiutr.)
Owners Nante & Address:- (�(�J% F L
Contractor Name & Address: 8nIg P4- E 1 ywf t ti- tom' 2 p
gT 8*0 Statc License Number: G�0490% a q?_
Phone 8c Fax: U%- 7 o7-56) - 0?9�ontact Person: ,m/t}2('S (� f�21 i'�i L�iePhone: Y S2
Bonding Company:
Address:
Mortgage Lender:
Address:
Are hftect/Engincer: 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 cornmeuced prior to the
issuance of a permit and that all work will be performed 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, ctc-
4 WM'S AFFIDAVIT: I ccrgfy that all of the foregoing information is a" -=cc and that all work will be done in compliance with all applicable.. laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT M'YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY_ IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LFEIfll:R 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 th.c public rrcoriq of
this county, and there may be additional permits required from other governmental entities such as water management district, state agencim or federal agencies.
Acceptance of permit is verification that 1 will notify the owner of the property of the rrquirementsg Florida Lien w, 3.
Signature of Owner/Agent Date. Sig aturc of contractor/Agent Date
Print Owncr/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is — Personally known to Me or
Produced ID
PO onrractor/A ent's Nam
, /s/o Y
Sig 'tore of Notary -State of Florida Date - -
FS.A cn��BBIEp&A"TpNown to Me or
RPMNISSION
EXPIRES: February 25 , 2t�7
1 f t�00.3NO1"P,RV FL Notary Discount Assoc. Co.
APPLICATION APPROVED BY: Md [� Lj / trtyng: _ `'Villi ie' : D:
(Initial & Datt) (Initial & Date) (Initial & Datc) ((nitiul k: Datc)
Special Conditions:
0_0\
030