HomeMy WebLinkAboutBuilding Permit Application 06/25/2018 01:00 - 7724663737 BOYLE PAGE 01
[1ALILAPPLICAUSLE
FO UST BE COMPLMO FOR APPLICATION TO BE ACCEPTED
Date: � � PermitNumber
3
u
r
Building Permit Applitation
Planning and DevelopmentServkes
Bullafng and Code Regulad anDWlon
2300 Vinglnla Amijue,fort Plarm FL 34982
Phone:(772)462.-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click a at the end of line
lY.i i:.�;;•d., ;t'Ye: ;r,J,• .:�'!1�•.';yv: .,r ':L`•g;�},j,.n .,ti�,,;.:l Y; .;
('.:. ... .... .. .. .. �.,,: . :, . :� '. ... .. 'r•• !;,.�'� w¢• i�f i:r,.;::� �i�.�ltci�i%C:ti% I:i;::•„•;...:,�:.?; .:!�=i�c%sr...,�
Address: 3 5
Legal Description i
Property Tix ID#: 1 -*-06040 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Frontes Back: Right Side: Le ft Side:
' J } ! r' •;^i':.4.'.['r .:i7?g;/ ::(lifiiE,'ia u'<'1:y;:1N. :�V515::15�hi'1[7"i•:6�yE4S';'ryNii;ir3;i'^1'7..t(:'�:,;:,:.�rr:'•F:V: 1
csl;'r•;-ci
't:T^p r �.. 'r;iG=? (1• •,y,.' Fair ..{y.r;;d1F. ri Iff
.n[ -1�•�,•. :} c:. �• •: •t.. ,{ 1. 'ri^ `�r '-r� �^:,�•"P`ii i'''ii:.,.
.: tnr.b..,Y,.,...,'!' .,.� .v:i'.t...: �. ,..L9..•.,:. .,..�.,..1,.,. ,,c; '•..^.Oa. �.n.5/. .� iaV'?{j:ri,1, •i•: :'�•t{Ii,1fA�},..R.sJ,t ,}
Li�CR. �tlGc - . fill MW LOW< A•t5 fU see Ik le, W
W"ser ti�od 14AUsa.30 -2.90, Air- Ar OADM 4- -
CaA y1 Ck"9 o,3D-230
.[ fi%a •Y• !.g,J;�,,.:f;':rYW,, i( •i ?iJn�.fb ._ l• b;',,.a;Sn1 P_••,v, :.,
[i S fi a
1 �.,:-•: •:`a;; 'li,'{::•t::t:5'�!^? ;,?:' %%•�.iS•''; :{!•r:+'"`•'•r:Z±J•
� .p/.r. :{:, '�.1'iU: SYv,ln, ..,;ri'.:,•,� ,�u.^ 66t:lr:s4�:'�:-'Ey�,9:`:,
;I. �r..•. I:P,.' ,� `'1 i. x:13v.l.fry�.��e: �vp. ('q'�1.'��•.n.
ditl a•work.orro ea under Uhsperm - e a appx
HVAC In Gras Tank 013as Piping _Sh ♦rs Elwindows/pours
ElectricQ Plumbing U Sprinklers U Gen rator Roof
Total Sq.Ft of Construction: Sq.Ft,of Firs Floor:
Cost of Construction:$ SS_3 _ Utilities:Li Sewer Septic Building Height:
• .i• •� + ''y, ern•' ,�b•: ..;,.,t;�'!;rR{�,;ta�pr.�c,,..,f;;_,�':5;'••v:;:,„.
12
, %�"; :s„ •;+ial%,t. �r� '.�::1r'�4�„}ofG�';re'ttr'�'•..e,,: :ifs.•: ,.t,}t•..;,r;1J_.r� };�,:.
b�iM-n Y :f.. ;< w11 ii i lh:..•o,Tk.l �1<'�:••:,'. ;.,.
1 r.._I� ' :•.•�. .,, :..,:",•:.•:".'*''r::�•'• 1.1..� .Y 9. b,}� [C',Y i} 'ef,..r4.':..h...1 frS�l�•j!•.A.•}�':. 1
Name SO Name: C
Address: of frime Company: Ar
City:,hApO rLe. State: FLI Address: A- rl I mi IPA11M 11 0
Zip Code: 3 dJ) fax: City: State:
Phone No' Zip Code:
E-Mail Phone No. ;L- 12+(41
Fill In tee simple Title Molder on next page(K different E-Mail:
from the Owner listed above) State orCoLdwLicense., G'A-l n_I
If value of mnsdvedan k 5758 or move,a F&CONEWO Nmike of omen k nWked.
06/25/2018 01:00 7724663737 BOYLE PAGE 02
[[FEE
PPLEMENTAL CONSTRUCTION LIEN LAW INFORMA-170N:
SIGNS 5WNEER: Not Applicable MORTGAGE Pte: Not Applicable
me: Nalene:
dress: Address:
Y: State• City:
-,r. Phone: State•
Zip: Phone:
SIMPLE 71fl.E HOI.bER: Not Applicable BONDING PANY: ., Not Applicable
Name: Name_
Address: Address:
city: City:
Zip: ! Phone: Zip: Phone:
I certify that no worts or 1nsts1h>tion has commenced prior to the Issuance of a
St
i cit±Q ntY m r�Hon that is granting a it will a�a holder to build the subjects re
ix in coniniiCta e House owfiers on rules th
structure,(Nesse consult vft your Home Owners Association and review your r nns wh�apply such
In constderatkm of the granft of this requested permit,I do hereby agree that 1II,in all respects,,perform the work
In accordance with the approved plans,the Florida Building Codes and St.L ucle G inty Amendments.
The foNtNAns building permit appliQttons are exempt from undo Vft a full II rremy review.mom additiats,
UMMY sbvctures,awlmmhgf Pools,fiottOM walls,signs,screen rooms and as uses to another narnreSiderift Use
WARNING TO OWNER:Your fetlare to Retard a Notice ofmiry result In your pavim trNt w for
improvements toyouur property.A Notice of Commencement must recorded and pasted on the Jobsite
before the first inspection.If you intend to obtain financing,consult with lender or an attamey before
commencing work or recordI!!g.Wqr Notice.of Commencement
signature of Signature of ntracta Akense Holder
STATE OF" _( .,A,� STATE�� jA
CAUNYY OF �;i
The irxgoing meat was acktwwledaed before cot: f he htgas acknowledged before me
Utls day of V 2a $by this day �e
LLAALVI
i (Name of person acknowledging) (Name of acmawtedging)
� I
(SignaWra of Notaryr%=uced
f Rorwa) (Signature Notary Pit of Florida)
Parson OR Produatb!Idnotifiq{Nen
i Persomily Known IdentARcation. y
' Type of i e Type of Id Produced
CH111671NE J.CONWELL
Coat Commissl�i N0.;»•;'' OIIRISTIN� ,
Ct1111N11{{kn N pA 017eSli S1 . �• � �lat
Come 899
My 0"M 61PIFA
ni; gwus§ ql 71. 4 0
NMi011MN{I{►yE11R• 50110{tl!4c aab `J••'iry�NR.
I
i
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLlrTE
INITIALS