HomeMy WebLinkAboutBUILDING PERMIT APPLICATION ;ALLAP,RUCABLE IINJ O IM-lilST IRECOMPLETED IFOR;AP,P,LICAiIUON-TSO ISE ACCEPTED
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CO # ✓s'9S ..e,NST;R,UCI";ION INFORMATION:
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0HVAC Gas Tank Gas Piping _6bLutears �Wodows/Moors
11 fle;etc l�m;�ng ❑5,priniklears � enerat`or Ejkosof � oh
eIF3.qf pitch
Total 5`ci,Ft of 6onstrvction, 5 ,Ft.of First Floor; ---- -
Cost of CobD
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OWN;ER\ ES;S;EE; CONTRACTOR;
Name UQ-I UIQ ry-, S D]CJL Names_ V-anc A
Address. 9,0. (-�bX )LB-7 -- Company,.'.nu( 'QY- `PVUrVlblllC7
City:.4n YLt - States TL Address; TS&5 Q)d D P AL.0
Zip Code;.LOCU5 I Fax, Gity: Ve $O f�P h 5tatet- FL
Phone No, ® ��— Z9 Zip Coder �[o0 Fax;--7-]2-b �1-3C�5
�E-Mails Phone too, ��-S��-3y�3
Fill in fee simple Title Holder on next pa'ge(if different F-Mails
from the Owner listed above) 5tate or Comnty licenses
If value of construction!is$25Ao or more,a PFconow Notice of Commencement is required,
�SUIPiP(LENIENT/ALCO;NSTIR(UCllI, �.N igt:ElN iLA1',, 11NiRORll1-ATiI;O�N;:
ID;l I,GI1tERf ENfa1NEER: IiU�,t l pp;tts b;ie IN�.O,RTSXG.E COLNd.P;ANY;. INot pp;kic b,le
IN�me: INlame; T
A-ddness:: ,Address-
city'. S'Uate
Zip.. IPilitoR$: .4i1) IP�bo,me:
1 TREE,SSI:MP,L;Ei(U7lLE1H,,01DER: _ INot.�P�p:I;i�alble IB0SMIX,13CO,1V,1:PANY: _;ot,�ppli4a;b;le
IName° ___ ihla;me:
Addnass:: I ;Address::.
Cityr cttyy:;
Ph,a
Zip, I Pi I rte: � Ztp: IP�hone•. -
li cenCify that irme worlk or itnstaltatlon Ihas uommensad Ipr,'tonto it iissua.rtae of A ip�erm;�#.
St.l,4' ie4aw,nt i ; 'Kesintoir pry mntagni, hat itstgr�antiing;a e�imit�iNill;lAWiFtofit�ietphepenrnitlholGLertt�Ibui:ldtGltescw,bte�t�s;rtu wre
otuhililh ils ii,n can, iot with,An, app',i,icable I�lomm-e Pi6mmm Ass,al ibOcin ntdgg,Ibytmws or Arkc ckoye i ni, ghat may Irestgict or Ipr �tblt�t�qh
sAreture.IF,lease�coRssXlt�w,lth�you,r It tome oafi+�aers�\sso�a'ta Diann Irevlewy0ur,daed jfo;r any,r�str, iorts whigh Imay Appy.
ikneortsiderAtiion of Ihe SrA,nttng of thus Ireq vested Iperimit,II 49Iher�by ree that II v�ui,il,iin s kl Ir p asit6,Iperfanm ha work
in,AgrLw large\with 1fte A,ppro;ued Ip,lans,'&Ne IF,lorida tB�ttldtng 4a4es And 5,t.it ii�ie Omni try Amen';mems..
The ifolkoWn,g buRdi,ng(perm,it Apphcatiions,are oeKe,,mpt ifirom Lw;rtderaol ng A ifivll Loam,w;rreR4y lreuiew:mo,m,,,A,ddiitliorts,
AimessoRy stmm-nes,sw,tmm qg pools,>fetm s,w-,a;l,ls,Aigrts,soreen booms An, A,mmgryy msesto A;r,Lother in,om-irwhde Nwil ome
\IN,AR,N,J,,NG TO 011WlNIEit:\Ypu..r-,fatlure to,Recard ca tkoti_ce of 4ornmen ement may,result;in your paying twice,fo,r
ig,ro ements to pyo''r Ip;r'glpertyy A INotlCe of Co I I mernicernem,must Ibe Ire�eor�le�)alnd Ipost_ed on the jo;bsAe
Ibefore the fust j s, tton.Ilf you,intend tEo o'btaii;n I jnj anon ,�t,o,nsu;lt X4,0 Ilelncler�o,r an attorney Ibefore
wm;me \worlkor;re4or4;i;ng\ouir;Noticeof�4om;rne,nce.rne;nt,
s
g, G ;�g,g, �3v�rner/LesS�e�G',,tr CtQr A entfior�Odtvner- stgRakW,reofC�O;ntrAst9,r/14i�,►tseIHgw --STA'TiE Of tFLOiRI;DA STATE Of[FLOBIDA
CO,iN PY OiFCj �� �C �/Q� COUNTY QF
7lh.efior&oing instru;me;nrwas egknow,ledged before;me The-,fargodn,g i;nstrurnent was Acknowledged,before;rite
thl day of 1�4 vt , 29� bey th,ls 3 day of_J2 flu �gT.2-'0 by
(NAme of person ACk,n9wledin�) (;Blame of person Acknowledgl,ng
n -214
(SlgnAt of Notary Publlc-tate of Plorlda) - - (-fgnavi of Notary Piubljc-State of Iordda
Personally Known OR Produce`Identibcatlo,n- - _- Per6onalty Known OR Produced Identlficatlon
Type of Identlflca;'or �rodaced.. w Type of ldentiflsatd
, 11111// � RY P
`O,�PµY PUeI i VIRGI RIDGER �M
CommlSsl9ti No, ;a a�: Conllsslon No,__ _ _ _. - #°= Notar7YIblicJ state l of Florida
Notary Pub is- ate of Florida , « —
':�9 a°oPc My Comm.Expires Jul 10,2017 =;; o,; MY Comm.Expires Jul 10,2017
- 26752 /'
Revised 97/:1�76w
REVIEWS FONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
:DATA - - - - -
COMPLETE
INITIALS