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BCP2010-08268LL " ~~~~~~~ Development 8. Neighborhood Services Department r 100 S. Myrtle Avenue, Suite 210 Clearwater, FL 33756 `~ Telephone: (727) 562-4567 Fax: (727) 562-4576 www. myclea rwater.com PLEASE F/LL BUT BACK PAGE- APPL/CAT/ON MUST BE COMPLETE BUILDING PERMIT APPLICATION 'ROJECT OCATION ROPERTY OWNER must have phone number) ARCHITECT/ ENGINEER PARCEL NUMBER d ~ / 2~ /~~/ 7 ~ / l D~~ l PROJECT/JOB NAME PROJECT ADDRESS LI ~ ~ ~'"~ r ~~ ~ Or- ZIP ~- ~-~ T BUSINESS NAME LEGAL DESCRIPTION OF PROPERTY C~~~s~'~ ~T/ - Cr/~7`lD PROPERTY OWNER NAME K e ` T 5 ./tom ~ TAO r C; ~ 7 ,/ J ADDRESS ~ ~ 7 ~G s- ! ~ n.~ `" CITY C~l.2c~ r c~~~n! STATE~ZIP ~ ~CJ PHONE ~~ ~ - ~©T (/ FAX STATE ZIP DNTRACTOR (please print clearly) NAME OF COM/PANY ___ C_( ~' ~~` !~ e~~ ~ ~ // / ~ ~ ~l ~~ LIC. HOLDER G •'(sC~r ( ~~~~/~ ~~ PHONE ~C 7~ if ~i ADDRESS/ O~`! / ~ c-. / Cn ~~'~ FAX ~~ ~~- Z~~>~ CITY ~( ~C /`~ ~-,~ STATE ZIP ~ ~ ~ ~~ STATE LICENSE # ~~G~ ~J 'S ~~ PCCLB # Contractor E-mail: Contact for this project a-mail: EXISTING BUILDING USE PROPOSED BUILDING USE ~~~ .r , GENERAL NUMBER OF STORIES BUILDING HEIGHT ~~NUMBER OF UNITS~_ ?ROPERTY CONSTRUCTION TYPE: I II III IV V VI; P OR U FORMATION SQUARE FOOTAGE: LIVING ~'~ ~~ COMMFRCIAI 0 GARAG EICARPORT F FAX PERMIT, PLEASE ENTER PROPERTY ADDRESS HERE: PROJECT DESCRIPTION: C l/ ~~ ri'~ P NATURE ==BUILDING ~ ELECTRIC I~`PLUMBING )F WORK ;.MECHANICAL 1~1GAS AFIRE (CHECK L~ROOFING (ENGINEERING C,?LAND RESOURCES ~LLTHAT APPLY) iLANDSCAPING FUTILITIES NEAR WETLANDS t~TRAFFIC OPERATIONS ICLEARING $ GRUBBING BOTHER TYPE OF WORK: ~ NEW F.,fADDITION EMODEL CREPAIR I.~DEMOLITION BOTHER GC- ~ ~Q ~ JALUATION: $ (THIS MUST BE FILLED IN, P LEASE PRINT CLEARLY) iOARD REVIEW REQUIRED: f~ DRC DATE: CASE (circle one): FL OR FLS # CDB DATE: ©APPROVED DENIED Anyone planning to do excavation work, must notify the one-call "CALL SUNSHINE" Notification Center at 1-800-432-4770, prior to any excavation work being done, in order to prevent underground damage. Federal D.O.T. Regulation Part 192, Sections 192.614 and 192.707. lpplication is hereby made to obtain a permit to do the work and installation as indicated. 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 the standards of all laws regulating construction in this jurisdiction. ;ERTIFICATION: HAVE COMPLIED WITH ALL THE FEDERAL, STATE AND LOCAL ASBESTOS REGULATIONS CONCERNING NOTIFICATION OF THE 'ROPER AUTHORITIES OF THE PROPOSED DEMOLITION AND RENOVATION PROJECTS. NARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR MPROVEMENTS TO YOUR PROPERTY. F YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ATTORNEY BEFORE RECORDING YOUR NOTICE OF :OMMENCEMENT. am aware of Florida and Federal Accessibility Codes, and I certify that I have met the requirements of both. certify that, tF~is appticaiigq n compliance )niith all appR~b~e a n violation of;th~ese laws~orFegu permit null an void~k'"°'"^° -;~~'--~-,; ~`~IS«'i~{ r S THIS APRf_'I~ATION € ..~ ,~ PAYMENT 6AETH~OD: .«V-1 C, ,,. , r Y ~ ~. signature Li~nse Ho/den with any plans submitted is accurate and represents all work being done at this time. All work will be done "gulating construction and zoning and if not I realize I am responsible for the removal of any construction ~ , Any deviation from information submitted, unless approved by the Building Official will render this ZESULT OF A STOP WORK ORDER OR NOTICE OF VIOLATION? YES_NO iCHECK " CREDIT CARD - If paying by credit card include authorization form. ~ -~ Dat-o-~_ ~/ease Print Name Here /Title in Fim- or Homeowner