BCP2010-10014LL
earwater Development & Neighborhood Services Department
100 S. Myrtle Avenue, Suite 210
~ Clearwater, FL 33756
Telephone: (727) 562-4567 Fax: (727) 562-4576
www.myclearwater.com
PROJECT
LOCATION
BUILDING PERMIT APPLICATION
PARCEL NUMBER ~~ / ~`~/~~/ ( l S ~ / ~d / ~~`_._ __-.._-___.._.
PROJECT/JOB NAME _tc~c~-~'Pr ~~ ~ ~ (/1P~ ,~~1 S Gca ~ I
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PROJECT ADDRESS ~~~~ ~~~~ ham .VIII Vl ZIP ~ tvN
BUSINESS NAME A/' PHONE / j
LEGAL DESCRIPTION OF PROPERTY U~rS~ ~ y ~ ~~~ S' Gx3,d~' ~ i (~~
X-~
PROPERTY
OWNER
(must have
phone
number)
0
PROPERTY OWNER NAME ~ N S~-en hPh f t~ ~~ y (~ ~~ ~ ~~~L~ ~~o~'IC e
ADDRESS r~~~ ~Q2,~ I ~ ~e rn ! ,r 1 y
CITY _ ~ \•r-cp V ~,(1 C~ ~ ~ / STATE ~ ZIP ~~~ Q
i
PHONE 7~ ~ - ~IoZC~" I ~ D ~i FAX I G
--~
NAME
ARCHITECT/ ADDRESS
ENGINEER
CITY
ATE ZIP.
PHONE ~ FAX Office Only
E-mail:
___
_____
NAME OF COMPANY ~.`uQr~ ~(/~C
CONTRACTOR LIC. HOLDER ~'P l i \~ ~~V ~ PHONE7~7 7v2S~~~~ ° i
(Please print O~ p ~
ADDRESS ~ p ~ ~ ~.. FAX '7~ 7 -? oZ(`" ~ /1 (~',
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clearly) CITY P ~
~~~ l~ ~UCa/ ~ l • STATE ~ ~ - ZIP
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STATE LICENSE # ~~ [' (' 9 ~.
~ ~ PCCLB # n -Zj
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Contractor E-mail: ~~YY . ~-- ~ ~Q c ~ r G~ ~~
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Contact for this project e-mail: ~Q ~ -~ C
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y
EXISTING BUILDING USE PROPOSED BUILDING USE ' ~ ~
GENERAL NUMBER OF STORIES BUILDING HEIGHT NUMBER OF UNITS ~ ~-~J
PROPERTY
INFORMATION CONSTRUCTION TYPE: I II III IV V VI; P OR U
SQUARE FOOTAGE: LIVING COMMERCIAL
GARAGE/CARPORT OTHER TOTAL
'
= Office Only '
PLEASEF/LL OUTBACKPAGE-APPL/CAT/ONMUSTBECOMPLETE - -- - -~
IF FAX PERMIT, PLEASE ENTER PROPERTY ADDRESS HERE:
NATURE Eµ°`;gUILDING ~::~'ELECTRIC `q~P
LUMBING
OF WORK
(CHECK ~°~MECHANICAL
° `~~"GAS
~~~-°~ .
~~.:~'..FIRE
ALL THAT ~~
ROOFING ~:~:ENGINEERING =.: LAND RESOURCES
APPLY) ~;u~LANDSCAPING M::wsUTILITIES ?._ENEAR WETLANDS
~;;.~TRAFFIC OPERATIONS ~:;;:RCLEARING & GRUBBING :OTHER
TYPE OF WORK: .ANEW ADDITION I~.~REMODEL f.~,IREPAIR ,r~DEMOLITION ~._..~OTHER
VALUATION: $ ~ ~Q ~'
(THIS MUST BE FILLED IN, PLEASE PRINT CLEARLY)
BOARD REVIEW REQUIRED: ?~..,) DRC DATE: CASE (circle one): FL OR FLS #
'..,;,CDB DATE: ~w.~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.
Application 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 pertormed to meet the standards of all laws regulating construction in this jurisdiction.
CERTIFICATION:
I HAVE COMPLIED WITH ALL THE FEDERAL, STATE AND LOCAL ASBESTOS REGULATIONS CONCERNING NOTIFICATION OF THE
PROPER AUTHORITIES OF THE PROPOSED DEMOLfTION AND RENOVATION PROJECTS.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY.
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I am aware of Florida and Federal Accessibility Codes, and I certify that I have met the requirements of both.
I certify that, this application together with any plans submitted is accurate and represents all work being done at this time. All work will be done
in compliance with all applicable Taws regulating construction and zoning and 'rf not I realize I am responsible for the removal of any construction
in violation of these laws or regulations. Any deviation from information submitted, unless approved by the Building Official will render this
permit null and void.
IS THIS APPLICATION THE RESULT OF A STOP WORK ORDER OR NOTICE OF VIOLATION? YES NO
PAYMENT METHOD: ~ ~ CASH ;...!CHECK F,.. CREDIT CARD - If paying by credit card include authorization form.
Si hJre of a Holder Auahailzed Personnei ~
Print me Here / rde in Firm aHomeowner