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R 14 N !;; N iP�EEi�; ot'App i all' MORtSAOE COMPANY:.! Not Appiicabl�
Norrie•
Name:
dYe Address:
take; city;
P. horn, .. Zip;
FEE SIMPLE TITLE IuIICDl.l 04 ,.�.Nta� co, W: I�tQT. le
Name: NarMn !i
Address: Aeddregs;
city
Lzi'PL
21p; Phone: I'
Y .
i cgrtify that no work gr install0go ha$cPmmPnci;d pr}t+r 0 the ts5yanc0 of a parmit, I
fit.! ate Cp4cn rrealc s no r�pre� ent Cir�n that lk r>aniint a ort>tilt will a thQri�ithp ermit hO: t 10 'Id th swbi�et i l tsar•
w is i$ihAon i4 with anyi r����Homo taw rs,4a Cr ation N opi.y Ows gr c� tgVeri4n t may r�trt t' i r 1.•�t t';}r>eh
strt}gturR. 0ase c sylt w "tip)YoQi,oftHomo AwneP;x �Ogio on and ro w fur pediar any rest �iran5 whist may s��?�y
in GQnsioerptttrn of the granting of this raque t d permit.►do hereby a$r�v that I will,In ali respdw,perform the w9rk
in av; PrdancQ i0th the approved plans,thio F19004 duiiding Cpdgis snd St,Lone�Aur►tY tam�n�im�nts.
The following building permit appiieat}bnS ire oRnpt from tAndQrgatng a foil pogqurrnncy ro4io,:ro;?m addltions.
accessory structures,swimming,pools,#en;cis,walls,dans,sergetn rooms and aomsgQru uses to 00ther n4ri-realdentiai pa q
WARNIINQ TO OWNER;Ygor fallurg to Record a N%tice of Commeincomernt>tct4y mwit in ynor Pi
#beige fQr
lmprgyements to yQeir proper.A Notice of Orrlmpncoment must be rpeorded find posted ori hq jobsite
before the first inspection. If you intQnd to Otain flhal6dni,conwif wITh lender or 4n attorney baWe
commen •in worn or re rdin o r NoticeOf C Mm' encement.
i ars I.as at44,gar►t S n a iwt r' . ergo . er
MTE OF FLORIDA STATE OF Fi ORIDA
COUNTY-OF CPUNTY OF JJAUJe�____
The 1`dr Wo igsteument was Peknowiedged before rite To farfina instrument was .4riowieadge.1 before-Me
this day of• 20 lei?` this ._dily of, by
Ana
(Name,of p�rsan act<nviriodi a {ivarria og pirsn akcis}wi�d rid)
i nature 0 Notary POO g f F.tirtda �t n urs of Notary
Persanally Known . M Prgducoo 1dentificatfon, PQrson0y Known„.,,� 'dIt Prody ced,identiflcatipn
Type of I4entiflcatigtt PrpduPed Type Qf identifigat}tin Or Li eta
APF
Opp k hetory Poona,01'0e,of Fiorldo
#Qramiir�inis+� ;iPii Ce.Oid)b 7.$9kp
R 11iPMl FRONT 2QNmra" supmviWR PI AhkS V1wOETA'fIC�P'! iRTGe MAN i$QVE
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INITIALS