HomeMy WebLinkAboutBuilding Permit Application 12/14/2017 03:57 7724663737 BOYLE PAGE 01
ALL AMtARLE INFO MUST BE COMPLETED FOR AMCATION TO BF ACCEPTED
Date- Permit Number, _ - _l � �o� • l�
Building Permit Application DEC
Pfannkm and Dev kpwnt Servkes .
Aulk aqp and Code RepulnWn DMMon
23M Wirginla AvenuZ Fort Plenz FL 34"2 V/
Phone:(772)462-1555 Fax:(77?)462-1578 Commercial Residential
PERMIT APPLICATION FUR: To Select from dropbox, click amaw at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 1
Legal Description:
Property Tax ID ft:„� t y �' Q� Lot No.
Site Plan Name; Block No.
Project Name:
Setbacks Front Back,_Right Side:�Left Side: --
DETAILED DESCRIPTION OF WORK:IR
lace. a. camuhl
+ ,
ton fi, t ���
CONSTJWCTION INFORMATION:
AddMqfna1woNT5b=rformed under n1sparmit—checKall appw.
HVAC LJ Gas Tank as Piping shutters El Windows/Doors
❑Electric Plumbing []Spdnkkws 136enerator Roof
Total Sq.Ft of Construction: Sa.Ft.of First Floor:
Cost of Construction:$ NO Utilities:13SewerSeptic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name:
Address: P Company: f
City_ W I State•_ Adore 1
ZIP Code: Fax: City: -L-P1kif« Stater
phone No. Zip Code:
E-Mall: Phone No.
FIII In tee simple Title Holder on next page(if different E-Mail: N if
frau the Owner(fisted slhd+re) State or County Ucense:
It value of cn 60 uction is$M or more,a RECORDED Notion d h required.
12/14/2017 03:57 7724663737 BOYLE PAGE 03
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MON N ..---Not App icable MORTS"E COMPAW:Name: ,, Not Applicable
Address: Name:
Address:
Mr. She' clitr
ne . state-
zip: Pho : Zip:.Phone:
FEE SIMPLE TITLE NOLDER: _Not Applicable BQNDiNG COMPANY: Not Applicable
Name: Name:
Address: .,,,. _ Address:
City: .,,..� Mr.
Zip: Phone: Zip; Ph me:
I certify that no work or IndaffWan has corrivneneed priorto the Mumce of a permit,
St e t 4u mak no n.�8 on that is ntinR a Pt v�llf�e t#nn pen-Aft}wider to build the sultject re
wh h in ed ict i nary a h Horne Owners�on racks, ora 8 coven7rtRs fftat may or such
Wuctute.Please consX vrah your Home Owners Association and roZwb your deed for any restrictions wh�a�
In oorrsideratim of tha granting of this requested permlc,I do hereby agree that I will,In all respects,perform the work
In aemrdance with ft mpprovesd pians,the Porida BuNdkng Codes and S't.Lucia County Amendments:
The following building permit applications are exempt from undergoing a fun concurrency,review room addltlem,
accessary Stns3ures,sWAMMIr g P°nky fances.Waw,Sim scrmm scums and accessory uses to another non-residential use
WAlilllillfN TO OWNER;Vourfsllure to Reeved a Notice of Cammenoemant may result M hour pWfni twice for
Im rovemer>ts to your property.A Notice of Commencement must be recorded and posted on the Jabsite
before the first Inspection If you intend to otOln ffnancinZ consult with lender or an attorney before
commencing work or recording ur Notice of Commencement
aw m of Own 9graalure d mritractor/Licenselloldw
STATE OF FLORIDA STATE OF FLOWDA
COUNTY OF cuum Y OF
The ins m was adewwledged bsfcxe rare The rag I erre was acknowledged before me
thfs�of 20 W " l `may 20_M by
17 c'F� 17 CW
(Name of person ac#nowledaing) (Name of piemon ndnawle4ng) ,
( aturc of Natary le--state of Florida) (Signature of Notary Pu of Florida)
Personally Known�OR k'nroduoad Idenotkation Personally,Known 7OR Produced ide dficatlon
Type of Wm0kation Produced Tw*of identification Produced
commission �•,,
CHRISTINE J�I Corom Ia11111"d J.CO
¢W&. FlOfidll M i{rj Ic•NM6 IIOi
GommIt411on N 84 Otys�9 commotion#pg 017011
MY
OlRill• n
0 baAald lArough Nglonta fblir�Aisn. ".,;;
12/14/2017 03:57 7724663737 BOYLE PAGE 02
FLORM ENUff CONSMATION CDDR
m et RVAC Change-ea
far awwt���aFtl�e dwyk INVIIe��e�en ka<�a[+�►taord yp�.�l7.is�k�s s�.st�
far em(U�
Raoul
1 lytl, !law.trrp dlh rl �reek�� NIt11 ue�f#a nwwe byOw p I aNd
atm�rtt!i �d k.eonVA&I"
p�Wl�rs nNd�ll,th! duds!�b�sai�1 �a�air aad�
. o pt�d�t�loc�ad wllbin�s�■o�.� 7s 1� ;.
0 1fM�nir�es ar �ai�ao�d1►MroNd tic��k �.++�.7�,3
o pyeawrt�asd dee em
�LOdtl,+l.�'.i,�wn�rllewe 3q
IZ 4
PA Noise
' � � ��YWi � I 1 IIIIAwr'nYry1�
■■ �wY �a�solace
�1lll�f� ! 111 R IMRIYWIr11Y ''1 IIAIRIY�I.e
lcw\ ,b" ce*kdkt%sWmv0VW*)�
d prrr� tlM e�yls PMS min,arllok