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BCP2011-01205Clearwater PROJECT LOCATION PARCEL NUMBER Planning & Development Department 100 S. Myrtle Avenue, Suite 210 Clearwater, FL 33756 BUILDING PERMIT APPLICATION 567 Fax: (727) 562-4576 INWW. myc%an~vater, com PROJECT/JOB NAME PROJECT ADDRESS ZIP ~~ / ~n.f BUSINESS NAME PHONE V LEGAL DESCRIPTION OF PROPERTY ~ <'~ `'~~ ~C ~~ /~ ~ ~ • ~ ' PROPERTY OWNER NAME ~ / < L • i ~ , PROPERTY OWNER ADDRESS ~,O ~ ` ~iP.G/~ ~J ~~ (must have phone CITY C~C.,~~~/QJr~A° STATE ZIP .7'.~ 7~. \ number) PHONE 71 T -L.~~ ~ ~-~` FAX ARCHITECT/ NAME ` ADDRESS ~1 ENGINEER CITY STATE ZIP PHONE FAX Office Only E-mail: NAME OF COMPANY /~ . (_.•~~C /G '~'~ C• LIC. HOLDER ~©Q,Z/!Z V ~/~~/E~ PHONE 7i~„~I ~~~C3 CONTRACTOR /+ /~ ~ r~ (please print ADDRESS ~~O 7 " / T~•/,L iv FAX clear9y) // ~~ CITY /4~'/~~ ~r~~~ STATE _ /~~ ZIP ~~ ~ ~~~ STATE LICENSE # ~/ G~ .r7 / ~f 2 Z ~ PCCLB # M ~ ContractorE-mail: ~2~~ ~p/j,~./~~S/ ~ f,~ /~~.G' Contact for this project a-mail: '+~ D EXISTING BUILDING USE PROPOSED BUILDING USE ~r Z -+ m~'' ,~ GENERAL NUMBER OF STORIES BUILDING HEIGHT NUMBER OF UNITS ~i N C PROPERTY INFORMATION CONSTRUCTION TYPE: I II III IV V VI; P OR U ~'~~ n ~ SOUARE FOOTAGE: LIVING COMMERCIAL ~ = ~ GARAGE/CARPORT OTHER TOTAL Office Only PLEASEF/LL OUTBACKPAGE-APPL/CAT/ONMUSTBECOMPLETE ~ --- - 4ti~~~ ~ ~~ 1~~~/ ~ l/~/~~ I IF FAX PERMIT, PLEASE ENTER PROPERTY ADDRESS HERE: !' PROJECT DESCRIPTION: '% - s~.v ,[.si,c. l~ ~ ~~i a ~ nil i-' /;= NATURE OF WORK (CHECK ALL THAT APPLY) ~,.~BUILDING CMECHANICAL PROOFING LANDSCAPING TRAFFIC OPERATIONS .:ELECTRIC GAS 'ENGINEERING UTILITIES !CLEARING & GRUBBING 'PLUMBING ':FIRE BLAND RESOURCES '!NEAR WETLANDS 'OTHER TYPE OF WORK: SINEW ~.iADDITION REMODEL REPAIR DEMOLITION OTHER VALUATION: $ ~ ~ ~'~ ~~~ (THIS MUST BE FILLED IN, PLEASE PRINT CLEARLY) BOARD REVIEW REQUIRED: ~ DRC DATE: CASE (circle one): FL OR FLS # 8,..)CDB DATE IAPPROVED 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"Iseng done, in orderto prevent underground--damage.-federal D.O.T. Regulation Part 192, Sections 432.614-and 1g2J07. 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 performed 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 DEMOLITION 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 laws regulating construction and zoning and if 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 IS TH#~ APPLICATION THE RESULT OF A STOP WORK ORDER OR NOTICE OF VIOLATION? YES_NO_ a PAY~dI~N~METHOD~w ~l CASH CICHECK ~ CREDIT CARD - If paying by credit card include authorization form. g.. ~~ Sig ,. #~~ ofLiae Ho/derORAuthorized ersonne/ Date P/er~B.%'• Tide in Firm orHomeo er