HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number.
Date:
PlarnJea and Developroeru se ices
Bu➢ding and Code ReaulctlOn Division
2300 Virginia Avenue, Fort Prerce F% 34962
Phone: (772) A62-1553 Fax (772) a62-1578
PERMIT APPLICATION FOR:
Building Permit Application
Commercial
Address: MOT llILn=---I—�—x---�c-
Legal Description:k 1 m\ it l 0 ("5 ` }�` ^
Property Tax ID =:
Site Plan Name: _
Project Name.
Setbacks =r
,nt Back_ _ Right Side: _ eft Side:
Mechanical
Fiectric
Gas Tank
Plumbing
Gas Piping
Sponklers
Shutters
lene oioi
Residential
'ctal Sq- rt o- Construction:
Cos of Construction: 5 2. Cc IO• oO utilities. S=wer _ Septic
Nam
Addi
City:
S?aie: FL
Zip Code: _AVILA Pax: J 14
Phone No. (l (17)-1-1Q- ( O LW I
E -Mail: N�4
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name V( Y;-tM V � k
Company
Lot No 32__
Block No. MIA
/;Nindows/Eoors
Roof
Buiiding Height
Address. 005
Ciry: State =l
Zip Code. 3Z 3 `ax: 32 i 277- 4Z3g
Phone No. 772.537-'{! 70
-Mall ::.iES�, {O G;1 Mia: a' _ ��.• _
aeie
or, Dcntf License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not ApphcaAble MORTGAGE COMPANY_ Not AppLcople
Name.
Name:
Address: Address
City
Phone: �, Zip: _ Phone:
IFEE SIMPLE TITLE HOLDER: _ Not Appiicabie BONDING COMPANY: _Net Appk3nle
Name. __ Name.
Address Address —
CItV: & y.
Zip: Phone. Zip.
certify tha-, 10 work or installation has Commanced prior tc, the su n-= o. a parmt.
$i _IICi2 CPunb! makes rc -epi1 a-uon Lha ulrK mlt wdl L * =
which i5 in conflict with any aophEable Home Own As50r at on rules 7v � - or C ov:.na h `naY i „r
structure_ Please consult with your Home Owners Aa sociat!on anc review you deed or any rest ict-ns whirr may apoh
!n consideration o` the granting o nis `eque� unit, h eoy e e • �a* w II !I res <'-ern he -:^.pork
in accordance with the approved Plans the Flo da B::ilding Codes. and S - _cin Corn v .mea r ..-.
The following building permit applica-ions are ex mnt from unce-eomg a oli conc�rr ncy -eo'ew- oom -d .ions,
accessory structures, swimming pools, fences, wall, tiers. screer rooms znd zcce_sory us=_s to ..�eth r nor -esdentiz: use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may, esult in your paying twice for
improvements_ to your property. A Novice of Commencement must be recorded and posted c- the iobsite
before the first inspection_ If you intend to obtain financing, conslllt with lender or an attorney before
comm nein work or rector ing your Notice of CommencementIF.
Si n Y•.r. e of Co racovllice_s2 �olda-
_
Si-nature of Owner/ Lessee/Agen- " g
STATE OF FLOflDAC'I STATE OF FLORIDA —
COUNTYOF T7"VC�►U COUNTY OF�ICIIC�
v r;omo .r. un ;. v.a no wr�deec core -
The rgoing ins[r uwr'nAent was ock o 1 2 �1 - -
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this day or T
eras
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Co ion. BROXESZIGEfI Commis : _— BROOKC LTI
` MY COMMISSION# FF 244655 °` MYCOMMISSIONaFF244655
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BondedThiu NotaryPublic Underwriters ." Ft��`FJ' BondedThm Notary Public Undewitem
Revised 07r'1312
REVIEWS FRONT ZONING Su7ERSi�,OR PLANS r t =. IOV SE; 7jR'LE VA NOROVE
COUNTER ':. REVIEW REVIEW REVIEW REVIPA REVIEW REVIEW
DATE -
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