2215 Oregon Ave 06-228 Fence09/08/0D 10:46 FAX
_. U 002/002
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crt'YOt�SAr4oRDPEVp4t"CAPP1ACA'I'IOiV
L'erntit # .V r— a CDate:
am�()_
JCI) Address:�)c,
•l�_(�t�1C l) 'l Ir U �' (7
Description or Work: ass t ) ��� �C�, ~� FirU+Yi�t yt • t ��f �'2CC;�� {.�� � `1.51 �� � 1 \ lC� �y ��
Historic District:-- Zo tttg: _ Value or Work: r
1
Perrtmit -Type: Building �Electrical Mechanical _— Plumbing Fire Sprinkler/Alamt Pool �^
Electri(W: New Service —f, of AMPS _ Addition/Aite,ation Change of Service Ternporary Pole ECEIVED
Mechanical: Residential �'on IZesidenlial IZcplecerent -,— Now (Duct Layout & Energy Cale. Rcolu'
,C
Plu;rhino==/New Cammercial: !? of Pixre�ces __...�_. R' of ti`'ater &Sewer L.inus6` of CJas EP 2 3 Line:;
Pluntbiug/New Residential.- It of Natcr Closets -,_ _.� Plumbing Repair— Residential or Coritmefcial _
Occupaucy Type: Residential _— Commicteial Inchi "al Total Square Footage:
nC 5t.^,:'ic;' ^, ncilii;y ;)hits: _ Fluod Zone: (FL A form required for other than X)
& Legai iYcscripnou)
A_. Namec4dres_ a. ,UV%Sl _� l nrw1e— Avr P�� 4c�—L—I- !_D____._.
-:, n e
:,,.,.....VVi1Gi' nnt�erPe: <,t:.M.is�a�it..icit�rCs6�.. Phdtl-_ 7-
/sudress:
e�, r. thlte(:t;�rv:n(;Ineet
Fax:
t„_r,..b.; rha4l. to 4c. dr_ the .,r.. nd icscallacians t 'i!at no :vom :)r iwtaliatioo has commenced prior to tine
srt of a i e.. ;tit and that aft tvcrk`a=ill Lt: r;u;mrd tun ', ,andards.of n ail 1 <. i regular Z c:?as�nc'si :) i..this juris3iction. ! unciccstr,a l that t, sa',Wcpaf
Fnr,ir I),urt e,N P.ccst d I'or'r.l..rCT .ICAL.. OkK_, P?,Uh1EtITlt_ ; SIiiNS,•iNE3f LS, P`.O _S, I;MNA`_ES, BOILL'Ra", FIPATERS, TA;JU, and
IijK c, iTif_,i,ir.RS, rtc.
15,,WMi_AI,. AnEIDAViT: i certify chaff all of the farnv(jing i^'ocma;lon'is accur.-.:a a:.d ihnt aft work will be done in compliance with ali applicable laws regt:lating
�.._.;,, 7. -::ril',�. t„�,._:dEdv T(? r WN'.ER: 'i 0U,K _ ? �- —r• N i t. - .'r i:' c
°:'uLU E Tv R%:.�Zi �C 1 i..i= ij, CO;v(�1cdnC,,..v`i..Pl't' ro.AY' R.ESUL.:f IN 'ti fUR PAYING
t,.'n cr z U'i.r iN'feivL) TO 0131'.vfn FINANCING, CONSUCT VATH YQUK LENDER OR AN
i.i 0 hlr`.'i bEFORE UCORDING YOUK NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requiheuhents of this permit, there may be additional restrictions applicable to this property that may be found in rho puhlic records of
Irum uli,ci } UVCtgn7Cn AI enfICICS StICn 3S water mana�F.ment diStIlCIS, s4?te a�CnCICS, or federal agencies.
Arcepta nee of pernir, is vc;rification mat !will notify the owner of the properly of the requiremcns oIFlorida.I ' r,aw, FS 713.
naeof
Sig uOADate Signaur fCovactodAgenDate
\,Print Owner/Agent's Name _ ,.,Print Contractor/Aeent's Name
Sigaa carof Nd�ry-State of I
JENNIPERRn S Zz
MY GOMMSION # DD 451161
EXPIR �: ��+'�,i
DondodThrutVoarf f'l1q'6R
AP1141CATION APPROVED BY, Bldg:
Special Conditions:
1�- E3-ems
lotida,," Date Signaturf tat 5f}4t f+'f3iY�1i'J1t 'Date
i�'' My Commission DD229486
Expires July M, 2007
Ily Know] Contractor/Agent is V Per on I to Me or
_ Produced ID _
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APPROVED BY
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JOB NUMBER
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DAT
1 4- 01/1"
Date
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