HomeMy WebLinkAboutBuilding Permit Application ALLAPPUtABLE INFO Mibi BE CONNIEM FOR APPLICATION T.+C!BEAI T
Date: Permit Number.
Building Permit Application
Planning and DmWOpm=tSe ftM
Building and CodeRegulatiari Division
23Qt1VnginiaAvenue,Fast heme 834982 :00
Phone:rm)a6215S r�={m?4s2 zrs =-Gommerda[ Residential
PERMIT APPLICATION FOR: To Select from dropbcK dick arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: .
Address: e, �. /
. f
Legal Desm-ptinn: � vt
Y1
PropertyTaxlD#: — Lot No.
Site Plan Name: 4 Block No.
Project Name: '
Setbacks Front Badr Rr'ghtgde:' Left Side:
i -
DETAILED DESCRIPTION OF.WORK: '
0-ij 5 6 6/1
CONSTRUCTION-INFORMATION
Additional work to be SaIrtOrmed unclerthis permit-- all p
i
E)C]BecU!c
NVAC [3Gas Tank Piping _ v —Swam n windows/Doors _
UPlumbing Sprinklers FIGenerator 0 Roof .
Y
Total Sq.Ft of Constructlow. t.FL of First Floor_
C. of Construction:$ LltiliCr5: Sewer[j Septi Building Height
OWNERjLESSEE: CONTRAMR:
Name d Name: ati
Address: E Company: c C- kAlh-
Gly. ,State:J> _ address: Ept6e imlM
Zip Code:. Fare air
-�� !moi State:_
Phone No. Zip Code:.3 �f g-)- Frax<7� �Yui'
E-Maik Phone No. ? 3 6
Flit in feesimple Holder on next page(ifddffermt E Ma lk
from the Owner Wed above) State or Cou nse:
If value ofcorrstrucGon Is$UWormom a REWWW Notke of C ammi o rem entlsre Amd.
I
DESIGNEIV1ENGINEEM Not Applicable MORTGAGE COMPANY; Not AppEcable
Name: Name:
Address: Address:
City: Stater Mr. State:
Zip: Plume: Zip: __r Phone:
FEE SIMPLE TITLE HOLDER.- ' Not Applicable BONDING COMPANY: Not Applicable
Name:
Address: Addr+em .
• Phone.---
P- T.yt: Plume:
1 cu ft that noivork or bwWkdon has a mnenced'priortothe issuarice of a permit
St Luck maloes rm�r[e_p onthat is nga etm It% Imt!m oesmltemm ho lts%tD buDd thesubrstrucatte
strutxun�e�� ��Home� a d reawyournfor anyanyat whid>Etts�imapplyR
Inconsideration of the grauft oftNus requested permit I do hereby agree that t wAN,in ail vespec%perform the work
u+aoaDr+danoewith theapprovied plam theFlava B Oft Wes WA SL LudeCounty Ammu m mm.
The fdlowbhg bu pwaft apptations are exmW from undergft a fuR ooncurrengr reftw.room addiftm
acry strudumsy swbnrning poolsr fences;wallk signs,;srxeen•roongaud amessm uses to another non�denttal use
WARNING TO OWNER:Your failure to ftemd a Notim of C�ittncuur�I ant may result In Y�-ilsB taerloe fiar
improvementsto your property.A Notice of Commencement must be recorded and.posted on thejobsite.
00 before the first inspection.if you intend to obtain finaj e00&consult with lender or an attorney befte
commen 'n vrroric or vw%"m%"Rg vour Notice of Commencement.
Signature of Owner Agent!Lessee- of Wntrac fijcenm none.
STATE OF FLORIDA STATE OF FLORIDA
ODtt!!t1'YO'F 34—A'Al k1 , COUNTYOF
ThefiaWngbwbumentwaswedgedb�-me � instrumentwasadmowledgedbef mine d
thlsl]•dayof 'n1g1,' i_,ZOXby thisq_, dayof .1y m"by
(MmofPersmitiHlYN� - Qftm p •a+ddv 'Yii
YWV
( of Notary Pubk-Stdt of Florida} ftift&bf Notary Public-State da)
PersoflaWbiown OR Produced tdeni ficoon Persondy Known_OR Pmduaed Id adricadon
Type of motion Produced Type of identification Produced
I{ �No. ^';'aY r;;J. (Seal) LASH HNA INGRAM mission Nth. i$ealj .
Notary PUbIi,Ct State 4t fi filo i�tiu+rry
=• _ a•E M Co F` ' _�r�Pa�P�saa u LASHAHNA iNGRAM
Commission #7 FF 177249 _ _ ra e o orida
X0711512014 oFo}�,.q, My Comm.E;:pires Dec 20;2018
„�s,•^ Banded through National Notary Assn.: -
I ' Commission #FF 177249
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OMPLETE
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