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Building Permit Application
07/25/2017 16:58 7724626448 SLC CODE COMP PAGE 02/03 07/25/2017 16:50 7724612035 STEVE SMITH AC PAGE 02/03 ALL APPUCABLE INFO„ kAUST BE COk1API E7 Bpi FOR A0.Pl lC1I1T1014r 70 BF ACCEP f Ep Date; 2'' �' Permit plumber: Building Permit.Application JUL Planning and Development3 vvlces Bulldinp and Code Regultrtibn Dlarlsian: PE€;:Ii X- 2800 (, WrglntuAvenuAFortMerceFt3i19$2l ::.' . Phone:(772)462-1553 Fax:(7721E 462.-1578 Camrnercial Residentlal PERIVIIT APPLICATION FOR: To 901W front dropbox, clinic arrow at the end of IMGWIMAIK�)J Address: l � • ' Crr Legal Description. > � r� �',� .lam �a�� Otz �1� "ZY6 ” PropetM Tax Ira;il: ��c� �—©D/O� Ago lot Ne. ;7 . Site Plan Name: ! Black No. -77 Project Name: Setbacks Front ftck:_Right Side: Left Side-._ A001tional wdMrrned :#. r s c a app y: 111At5 Tank a$ Plping Shutters 1:1Wlndows/4bom ClEiectrit Plumbing Spr7ttiklh QGeneraator �no" � i pltalt Total Sq.Ft of Construrtlornt � q.Ft.of First r: Cost of construction:$___.._. �;� . .___ Utilities: Sewer Lj5eptic Building Weight: 7►Name g r a-- - -- Name:s%"Smhh Address: Company: Steve Svd1h Air CnndWoning Cty: 1. r Stote: Address:8004 Ilan Read Zip Code: :��.1I Fax: city;Fork Plero9 Stlxe;E�— Phone No. 'Y — —lyre Zip Code.1149S1 Fax:M401-2=..--- phone 4Bf2896Phone No.772 467-4425 Fill In fee SIMple'xitle IWer on neNt page(if different E-Mail:®kevaatnilha�aol.corn N Rom the Owner listed above) State or County License:CA 913484120071 El value Of son6trUL'tlOn 15$2800 or mom,a RECORDED HdgGe af ComteerAOM t Is reVIrm. i 07/25/2017 16:58 7724626448 SLC CODE COMP PAGE 03/03 07/25/2017 16:50 77246120aB STEVE SMITH AC PAGE 03/a3 DESIGN5RIINGINEER: x Not Applicable MORWAGE COMPANY; x Not Ap IRM7ble Name: Name: p 2ble Address: Address: c1tr. i State; Cltv: State: P Zip: h ne. Zip.'_Phone.- FEE SIMOLE TnU HOLDER-- x Not Applicable BONDING COMPANY: x NotAtoplicable Name". Name: Address:' Address: city.. 2ip. Phorti, Zip:--Phone: OWNER/CONTRACTOR AFFIDVIT:Application Is hereby Made to obtain a parmit to do the work and Installation as indicated. I certify that no work or installation ftstcummenced prior to the issuance of a permit St. mit �11 authdrft the. It holoqW build the subimt structure 0*'a"u61 n and 0� 30� g 'n thatl� do agree that I will,In all mpects,perform the work makes d rep' ini, n11 t with erml consult 4app Hon� structure; s co c I rules:bylaws or aercownants t t may.Griot r prohibit such I uct�.Please w h r aw your'deed any restrictions 01 On may apply. in wmldwaW of the otins a this rnlu�a p nam 6 Godes no accordance approved plans, 0 Florida�lldln d St.Lude County Amendrnmts. therp rove a 5 The following building Per &PPI10aftilS aire exempt from Aindergolng a full concurrency review,room' additions, accessory Structures,swimming pools,fences,walls,signs,scmen rooms and accessory uses to 11"ther non-residential use WARNWIG TO OWNER:Your falkqeta,Record a Notice ofCammemmment may result in VftrVqW'ft9Wc0for ' e to your property.A Notice of Commencement must be recorded and posted on the jobsite oret,erstinspection. Ifyou:.-Intendtoobtain flnancin&consult with lender Of AA attorney before me cin rk or recording ir M^+lce, Commencement, 61gnvtvr4V Owner/Agentl Lessee Signature o.f rftense Holder STATE OF FLORIDA STATE OF FLORI_QA COUNTY-OF L6Ai:%e_ COUNTY OF The fornift instrument was acknovAe6&gd_befbro me The for ft instrument was acknowled&410 before me ,aav or this, of lk 20= ay — 4k=Lg�-c 2OLqj by this --5izbazk� by com n fam, of rn Ste (Name ofoarsonacknoviledging) (Name of person acknowledging (Signaturit offtbry PuMic".'State oaf EFh,rida 1 (SiPa re"o NotaryPUh1ic-State ofFIodda) Personaff�Known—OR Produced Identification Personally l(riown _OR Produced identification Type of Id6ritification Produced—,&�-IL�=— Type of identif6Gn lfroducedrL �� Commission No, It 5 (seal) Commission No.fp 1z 3+;ERJC UAW (S"'6C DAVIS NOTARYPUSIX 299ftWTARYPUBLIC rNMEDF FLORDA Re wsed 1512014 o90TOFF10M FF10M -- res 3M4 tires WWII RMEM. FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER RMEW REVIEW RWIEW REVIEW REVIEW' REVIEW DATE ; * DATE COMPMD