HomeMy WebLinkAboutBuilding Permit Application ruc.liir�4p�-aaaa rex:[//ij4oz-15/Z9 t-urnrntrrtadi Kesicienvai
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description.44&�A [A-06- rAA)
Property Tax ID#: ... 5t)() — Goal
Lot No,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:___... Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONST CTION INFORMATION:
iaTmork-t6benerformed under InEs perin-If=cWklall In appy:
HVAC Gas Tank E]Gas PipingOGenerator
Shutters Windows/Doors
Electric El Plumbing Sprinklers Roof
Total Sq.Ft of Construction: Sic,ft.of First Floor:
Cost of Construction:$ 4100.,00 Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name S Name-
Address: -• Company:
City: State: Address:
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Zip Code: ��Ea51.-_-- Fax: M City: f1�!it tei'C Q. -state: FL,
Phone No. zip Code:"VJ 1 Fax:711- �Q 3737
E-Mail:_ u.�1G-��+D551 �- y000. com Phone �Rg A 41
Fill in flee simple Title Holder on next page(ff different E-Mail.
from the Owner listed above) State or County lIcense:
if value of conshucdun is$2W or mora,a RECORDED Notice of CQmmenoment is required.
1, �� aaz \�a1 �1 RECEP."D JUL 12 2017
07/12/2017 10:21 7724663737 BOYLEAC PAGE 02
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNS ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
o11: State.• City: State:
Zip: Phone: Zip: Phone:
EEE SIMPLE TITLE HOLDER; _Not Applicable BONDING COMPANY: ---Nat Applicable
Name: Name:
Address• Address:
qty: City:
Zip: Phone- Zip: Phone:
t certify that no work or installation has commenced prior to the issuance of a permit.
St.l� a Cour�t�makes no on that is ntln a It will a orite the permit hold to build the sub eCt
which to ccrMiict with drry ppm� I�Fiam�e Qwneis rotes,byaws or antcovenarits t�iat may or prohibit such
structure.Please consult wltft your Home owners Association and rcuiEsw your deed for any restrictions why apply.
In consideration of the granting of this requested permlt,t do hereby agree that I villi,in all respects,perform the work
in amordance with the approved plans,the Florida Building Codes and St.Lude County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wails,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Comnwn"ntent maty result In your paying twice for
Improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection.If you intend to obtain financing,consult with lender or an attorney before
commencing work or recordIES your Notice of Commencement
Signature of Own a Signature of Contractor/LicenseTfolder
STATE COUNTY00F FLORIDA S�' �11�1�.- -- OUNTYot��t�A" 5� LUGie,
The forgoing instru was acknowledged before me f�lday off rumen was acknowledged before me
this„(�•_day of _, , 20 b „� �
F
B0141 1�(cclna �ay
(Name of person acnowl g) (Name of person ng). .
(Signature of Notary. of Florida) J signature of Notary of Holds(
Personally Known OR Produced identification _ Personally
Type of Iden Type ort idsntifl cel CHILsT1YE J rgyw
J. LL ftwory Public-$190 of Floridt
Commission Ir1gt1►wilic•(�pp�fjKle Commission N Commission�b"IM3it
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Mit Cenitli.Erpira A 21,2I>40 0o11tlttl thr
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Notlydt Atte,
Revjsr t 0
REVIEWS FRONT 20NING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
07/12/2017 10:21 7724663737 BQYLEAC PAGE 04 ._
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