HomeMy WebLinkAbout4616 MORNING DOVE LN - APPLICATIONS - 10/6/2011O,ot 06 201.1 6: 51 AM HP LASERJET FAX
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Lei N lCnoi'd1°pn`•nt s rranq�ranon
Fort cai� �CpA� P.o. eox sso
Phone 97Q-416-2a07q�p 4
Fax 224-6134 �� L 7�
a to a u•.d ��IY�COUIVTER PERMITS ONLY
❑ Heagng Un (f or rtpn structural) d Electrloal Alteration (not rv�ItS o�neciy (check a!1 the a�pP1Y) ❑ Air Conditioning
❑ V aaftal p Water H Sprinkler Q Mobile Home replacement �'Rooctr�ge) ❑ Gaa Lighter q pae Log
manila) eater ❑ Water Line ❑ Wood/Pellet St s7 sewer Line ❑ Photo-votWc
0"01e10 all Stove (must be SPA Certified, provide make, model and applkabte lMarmatlon on the appliaalan, Ines
AppllCation # D &u ss �� apoucatione will not ba accepted.
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3ab w Addraaa rre�r aled> -
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Property Owner Name 1���
Applicant Name
�
�rb 2 UC P2i(r
`1'7 t i.,�cx u� d E ,rlc r-ti O2 c S
Canbaft City of FL, CoUbw Sales Tax #
Value OP Coft"U tlon (labor, rNbulals, profit)
$ (Io ^ J )
Address City/state
,n, (� ZIP phone
�L 174- /% I',.S wo) ter„ 4J,24-
Address City/State Zip Phone
Address C�h'/Staff Zip Phone
Are you pay4lfj IZIXS� here or by report? 11 Hare ❑.Report
Are You paying with your trust account? GROVES' * No
Is this a residential or I project? Residential G Cortrmerrlal
if residential, is R; Family 0e41dled 13 CbndQ/townhome (single family attached) ❑ Duplex
rage
If commercial, Is it. 0 Bank 17 8tlr Ct 3 Church O HHootel/Motel q Medical CN N
pmore? OfVke O 0Mce ❑Retail
r es O fi
ifIe this bull ft Bo 1me this is for a d.molltim permll~, what year was the building1w4 J owatrucbed? rer+d 90 yA:tvr>teAANw V n
IfPAhrfl9Mu *0need an askaws aueisprlrn'!0 h bfavp
De salption of work
*If lawn
prsventar, must Nst Ucer*W plumber, if first-ime A!CC, must Iist Ikensed elertrtcian.
auboontracium, 4orrmr=r-0 &VrrelnreOra&ofFtfb&lw/kegtSlrl0
Plumhcr Med:ardcBL. poorer
—,..� Other
I hereby admiowbetip that I hang react this application and state that the above Infomnatlon Is COmpI80 and owrect. I agree to
0wrV r with all r®qulreww is contained herein and city ordinances and state laws regulating building construction. I know prat a
parndt Is aet valid antll it has bean P41d and Issued,
AppYanb
Print Nwoe: . " gigns"Im
Ante f C1 A, / 1 I