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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
2atel permit Numne'
Building Permit Application
_- -_and Deve!oomem 3e-:c_
3w:o�ng ana Code Reaulcbon✓irsron
2300✓irginro Avenue,Fors Pierce FL 3498Z
Phone:(772)=52-1553 Fax.(7721^-52-1578 Commercial Residential -_
PERMIT APPLICATION FOR. (�^ � � t�
Address:1 O C1� / NV \ 1'75Y� 'ICI-P YCP -4-
Legal Description: \ - _
IProperty Tax ID I 2 - (Rog _ l I _ _ Lot No._?9
Site Plan Name. \�� �� p r� Block No.
rP,ea Name. M �'Y N W y f� CAA ll
Setbacks =rent Back: Right Side. Left Side.
-
n10AAdiNtionalwomtoiaeperhOrmed un er rs err -check all that apply.
Mechanical _Gas Tark Gas Piping Shutters _._ ��.ocws/C-o s
_Frect.i[ _Plumbi`ig _Sprinklers _Generai0r Roo,
ctai so o Construction: Sa -t.of-1r .`loot
Cos or Cons-uction S ' -_l J V Utilities Sewer ,Septic Building Height.
Name'
Acaress. Conpany. n r r..•.�.r s "o ��d, b. �c<:;a��.
'SStale r Address: 008 Dr
7,C coca- rex: x/UI1-1 City 3e>cn State'.=!
'none No.� -�A0 U - Is 7_1p Code. 3 g.3-7 -a,,: I--,72- uZ3d
E-Mall { }. (, { phone No TiZ 337-Ut17^
Fill in fee simple Title Molder on nett page(if different E-,nail.
from the Owner listed abovel Stare or Count%Lic=ase. (?
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Notapplica bie MOft?GAGE COMPANY. _No- App Rabe
%ame- Name:
±;dbress I Address._
e,r State City. Stave-
mp Phone: ZIp Phone
PEE SIMPLE TITLE HOLDER: _ Not plihcable BONDING COMPANY: _Not Apollcable
Name. Name.
4dtlres- Adores,
cil
,. drone. Zip Phone
.,_ lth L ,c rS'a a-o 'IsCo.me [ oor tq tire Is, b a'e t 1
11 c u ''��makes a pr s r on that.,e a t ng perm will authorize Pa '�2,older ou Id e s o c [.ugure
wh s r onfl Icawith any apple[ nl i1 me �n s Association les.by. +s or arc o 2 ,t5 thatmay-e p Jh.b1-RJCf
Q Please zonsuh with your M1ome O /ners Assoc i ton anC e w your deed o'it 25tr R 1 which'a''no"
n:�J"'S:pe ci:pr`0 the granting Of tn15 ragvi teC cern.IL i do hereby agree t'^ar'will,In all reSP?Gs ne^orm t_he wort
.occ.rdance w£r-he aoaoved plans.to gor,da Bmldjng CoCe$-,o St l!ce County Cmecdi'll
'..e foibwieg omldme oe-rl aP"Peo-tens are exempt from uneargoing a lull mecl,mency-eNew mom aec,ors.
-lesson 9,nj¢ur_s,swimming occe feces,wells,signs.screen moms and accessory usesr another non-residenral use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may rill in your paying twice for
improvements to your property.a.Notice of Commencement most be recorded and posted on the lobsi*e
before the first m5pe¢Icr. If yec intend-o obtain financing,censu8 with lender or ac attorney before
•Tr^ cin worK or recor �n YCUr Notice Ci_Cmmen Ceme, t
` 1 `L a Age.Y 5-§ :ure O a s scan eolpe
STATE OF F IDA STATE
COUNTY OF COUNTY
[ e`ergo�g Instn mt was ackcowleaee :o -+e Tha orge•ng•� - - - wlsa5 so-e _
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I . .n- c ,Y BPOOKESDGETI C1,- smr No !�'"••' .p'==FY _____
' EXPIRE ti iuna25 0 9
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-' ells °RONT ZONING SUPERVISOR PLAN5 VEGETATION SEA-UR-LE MANGROVE
COUNTPB REVIEW' REVIEW REVIEW REVIEW REVIEW REVIEW
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