HomeMy WebLinkAboutBuilding Permit Application I
Thursday,March 29,2018 j
12:28 PM
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^ Permmit Number: O 'De q9
Date. ryh� 0
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Fhone:(M)462-1553 Fa?c:.VM462-15T8 ODMMerdal Residential
l 1 FGWrrAPPL1CAnON FOR To Select from dropbox,click arrow at the end of fine
PROP lMpfaOVBV MLOCA-nO1\k. i
Addressa 'N �/
Leo Description:
Property Tax ID# - - Lot No.
Property I
Ste Ran Name: Bods No:,
------
Sabacks Front Baric -- IgM Sde: Left Sde:
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IOownON-
PIUB110nal WOIK 10DeCIWMUnder Inispermi—cneCK all I WK apply'.
JWAC GasTank, �fiping 9lutters a111QndawstDoors', ! fi
OBectric 0 Rumbing I Opdn lens O Generator ❑Imof Root pdch
I Total 31.R of Oanstr R.of First Boor: ;
Cod of Oanstruction: �T- PO Utilities:F1 wer LJSeptic Building
i'law:
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-OVOJMl». ::, OONTPACTOR isl f.
:Name Name: 1
Address O W Gxtt�ny: I'
k Qty: 'Our 71 SLC .3 : — Address i. !
Zp ODde: 5 Fac Dty: Sate:_
PhoneW.!-7 Z 5759 `75 3 -Zp(ode: Fac
1 EMail:C "A'PPL•NN-A_Eu A-C one No. 'f
-E-Mail:
' Sate or{bunty Lioense:
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Unfiled Notes Page 1
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a.lPPl:EMf TPL OtNS iUnCjNCJev AwiNFORlnA ON:
D®GNER EWANER Not AWlicable MOFUGAGEOOM Not Applicable
Name- — Name
1 Address Address L O
I ap: �� - � • - Vie. Q0-
Qty Sate Qty I, a_t
} F _Not Not APphcable APp11sable � f
Name. Name:
Address Address
1 -Qty aty: r
Zp: F hone: hip: Phone:
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OWMM OOMRMCfORAFRDAT:ApplicaQionisherebymafetoobtanapermittodotheworkandiir3allationaymtinted
I certify that no work or installation hascommenced prior tothe issuance of apermit.
f 3.tucie, makesnorepreentationthatisgantingapermitvnllauthooaethe mitholder.tobutldtliesubjedstructure
whch is inoonflid wrth any applir�le Home OwrrersPssoaationrules byla wsor an�pe�Merl ntsthat may,restrict or prohibit s ich j
i 1 structure Hesse consult wrath your Home OwnersAssDdafion and review your deed for any restrictionswhich may apply.
In.cormclentidnrof the ga ntingof this requested permit,I do hereby ageethat]wll,in all respects,perform the. k'''
i inawNclanoewiththeapprovedplansthe Ronda9rilding(bdesand3.Luaeo)untyAmendments l
'Thefollowingbuildingpermit applications are exempt from undergoingafull concutrency review:room additione, i.
accessory structures,antimmin9Poolsfences,wallssigns,screen,roomsandaccessory usestoanother.na►1residerrtial.'use
WARNINGTOOWNER Your failure to P--mrd a Notice of Commencement may result in your Ips'ging twicr for
irr�tovem sto your property.F- e,�nt
ine of Cbmmenoemerft must be recorded and pasted on the jobsite
! ore tli t �i
your.
U youd to obtain finanong aonsvlt with lender or an attorney before
commen work or reeordin otice of Commencement.
Sgnat..
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I'JUIAgent forpwner, 9gnaturecfCbntractor
/icenseHolder
STATE DA SfATEOFRDRDA
OOUNIY
OOtlNNQF
The forgoing instrument wasadmowl before me The forgoing instrument wasadarovuled befweme i
this .dday_r.of 20 by this_dayr of t_by }
IyFame.drfpersonmabngsta<emerd
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PersmaDy Vnown CRRroduded l&-rt firYror Fersonal Knorm ORRoduced Idlentifidation
T of I rfication ^ - Type of Identification
Ddd, Ya I�vYP,t (.1 S l vim- RQdua_ed --
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�.Elg afureorNotary Public- ofRorida) (9gratureofNotary Public-Sate ofRoiida)
Ormrnisson W. (sad) Cbmmrs ion No. (sad)
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Pev.8/2117
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Unfiled Notes Page 2