HomeMy WebLinkAboutBuilding Permit Application 12/20/2017 03:27 7724663737 BOYLE PAGE 01
ALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:--a 201 n Permit Number:
Building Permit Application
Planning and Development Services DEC 2017-
Budding and Code Regulation Division
2300 Virginia Avenue,Fort PiEme FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the and of line
PROPOSED IMPROVEMENT LOCATION:
Address: 5
Legal Description:
Property Tax IU li:__-----.J'3_ C7-('- - ) w— 0001 _ 0420-,0 Lot No. _
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
b( U4, J60 AW WAOK
CONSTRUCTION INFORMATION:
Ad!ldItIoV worK toDorme under s perm -ch-ec a apply
HVAC flas-Tank ❑Gas Piping Shutters FlWindows/Doors
[]Electric El Plumbing Sprinklers OGenerator Q Roof
Total Sq.Ft of Construction: .Ft.of First door:
Cost of Construction:$ (0100-00 Utilities Sewer ElSeptic Building Height:
OWNERf i.ESSEE CONTRACTOR:
Name Name: j
0 11A&
b1
Address: Company:
yJ
City: Stater Address:
Zip Code: Fax city: (- PP ce- Stater
Phone No.-i-I - 4 Zip Code: 3451 Fax:-M'gt'Dlp__ ,w
F-Mail: A)I A Phone No.1-U- 4W 41+1' —
Fill In fee simple"ride Holder on next page(if different E-Mail- on' tom vie
from the owner listed above) , State or Co my ucense: .C _1212174,
If value of construction Is$ZS00 or more,a IMCORQED Notice of Commencement Is required.
12120/2017 03:27 7724663737 BOYLE PAGE 02
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DNGN I NGINEER: —Not APPlic able MMGAGE COMPANY: � Not Applicable
Name: Name:
Address: Address:
City: State, City; State:
Zip: Phone: Z#p: Phone:
EEE SIMPLE TM HOLDER. __Not Applicable BONDING COMPANY: —Not Applicable
Name: Name:
Address- Address:,
cftr• Thr•
Zip: Phone: zip:__ Phone:
I certify that no work or Installation has commenced prior to the Issuance of a permit
St Jude Cou "t, no rep ter that is granting a permit wIN authorize tfie iz holder to build the bjettnq 0eture
which iS moarrim airy appl3e Mom+G Assaraxtion trdes,bylaws or a�crvsts that may or p 4+ �tdk ssscft
strucwre. wnsutt wdh your Home owners Ass4datbn anti review ya►r deed arty restrictions whkh may spI►!y.
In conslderatlon of the granting of this requested permit,1 do hereby agree that 1 will,in all reset,perforin the wont
In amordance with the approved plans,the Florida Building Codes and st lode County Amendments.
The following building permit applications are exempt from underIlp"a full eoncurr+encnr review.rooms addkk ms,
accessory structures.swimming pocks,frsrcm walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your hilure to Record a NfStke of+Came enconewt may resuk In Vow pwo*twice for
impmvements 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 attomey bef6re
commencing work or recording your Notice of Commencement.
Signature of own tA8 a SWWtore of ContracWtUcense Hower
STATE OF R,AfIIDA STATE GF H M!!DA +
COUNTY OI COUNTY OF
The fti��r�a� ng i ment ariawwledged before me The iaa ng Instrument was ar fourMedged before w
this 2Q'�Iay�� 20 A b9 this OFIVI fnbr�20_W by
ri
(Name of person admoW ) (N+rme of person ) .
{Signature of Not'a_It State or Florida) (Signature of Notary State of Florida
Personally Known OR Produced Ident iNxtign Personally Known _ OR Produced Wentiffimoon
Type of Idem totlon Produtxtr� Typo of I
•• CHRISTINE
t
Commission No. a�f` OrM:TCONWILL Commission No. ry 1`0101141
"llatsrli tr at Floftat Florid&
oomntbEia►l►1;0 41X839 Conmilli"M 68 017830
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Revised 07/ ,f +i aortQao thronpl►Nspdr►si NMMy 011 fl. 0* Now wary Assn.
REVIEWS MONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
DATE COUNTER REVIEW RVAEW REVIEW REVIEW REVIEW REVIEW
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