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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Building Permit Application �c- _ _ .-3eveiopmerr Se^-ices &wamg cro Code Regu?ati©n Division 230C'✓irgrnraAvenue,For-,Pierce=r 3-198.2 Phone:!7721Z62-1553 Fax:(772}r62-1578 Commercial Residential PERMIT APPLICATION FOR'. ddrass tI�D.1_.� �LL {t�, )`� .?�i/` 2� =gzi Description ` � �� 'S _\ rT t�� ��. . Li �rir? �1 1 Droperry Tax S] �^Y 0 - �D2r V lllJ_ �, Lot No. Site clan Name- Block No. grclect Name Setbacks =rout Bask Right Side- Left Side. n J /�% / y(Ddyc4 fT�C�ya 'DA 17-1019 1f INtona wo to pertormed under this permit-CM ec'k BIT that app y: Mechanical Gas Tar:k Gas Piping —Shutters ✓/LNinuows/Coo-s ciectric _Piurnbrrg Sprinklers _CA-erator — - d `c G -tai S o Cor,ttructior: Sq Ft.0 �r r=ipgr l ws-of Construction.S i? �. � Utiiities. —Sewer _Septic Building Height. Narn2 Name _� � R AcCress. Company TIN', .-^��15� t lX_y� b& rcr=aat x JP41 Sate L Address: l f-' �. Zip Code- *:ax. - : City State:' more No - Zip Code. -34,F3-' ax: 32-L TEL g231? E-Mail. �{ L--{- Phone No. 772 4,470 Fill in fee simple Title Hoideron next page(rtdiferent E 'Mail_ from the Owner listed above) Sta—.or%ouJrt'4 L+cease tI va€ue of construction is 2500 or more,a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER _Not Apphcab''e MORTGAGE COMPANY. _Not Applicable ' Name: Name: Address Address. C.Tv State:_ City: State:_ Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable i BONDING COMPANY: _Not ApDhable Name: Name. ss- i Addre Address Cih" city: 7ip: Phone: Zip: Phcna. c_=.uy that no wer4 or,ntallation has commenced prior to the issuance of a permit, St.-Jc Courry makes no repre5e'La Jon rhat s granting pemmi 'li llthorize tie pen n alder build the subi ct t ucure whicr is r mn tia with any applicable Home Owners Association rules by.aws or and co er tits that may rerma or prohibit zucn sbu^ure.Please consul:with your Home Owners Assoc-anon and.ev_w vour deed fo any resV'ct on which ma, apply. in consideration of the granting of this requested permit.I do hereby agree:=at l wilt m all rudde s.perform the work :n accordance wits the approved plans,L^•e°lorida Building Coces and SL W<ie Couniu Pmeedmens� The following building permit applicaeiors are exempt from undergoing a fuli coocurrency review:room additions, accessory struRUres,swimming pools,fences,w311s,si€ns,screen roams no accessory uses to another no.^.-residential use WARNING TO OWNER:Your failure to Record a Notice of Commencement may resuk in your paying twice for improvements to your property.A Notice of Commencement must be recorded and oosted On the jobeite before-LhA first inspection-If you intend to obtain Financing,cons t with lender or an attorney before rommen worK Or reC i you, Notice of Commencement. _>ignatare of Owned Lessee,'Agerv, o W no.."-ilturou 1ol�v STATE OF FLORID STATE OF FLORIDA �p ' COUNTY OF A� COUNTY OF ��y�Cl A r4 -tie' g' lee€eqy -,e she f gona 9' ledg1ecp- ro-e-e ih;z da cr qy'" ,(2,Lab- to s Oas of InV �✓ 20 br esko 1 ULIv at..o 'Name of person acknowledwrig 1 (Name of person acknoLw^lCe--dg,rigg rtJ /1�/:�(4�A�Q1�V��J�CQ///' Signature of N 0a ­,'Public-State or Florida 1 (Signature of NoTaPry Public Fii5 r Roriaa 1 -ursonally Known CR Produce - ,r on_ ' Persoraily Krown-DL OR produced ider-.6cauor Tyne or idemification Produced Type of Identification Produced /1 iml on No GG 115 � d ��/ _Dn ' �•, 'Ma olFWiy� ffpren Pualic SU*N Fi 'elk e,yT ACNey M Antwelh Revised 07,"3/2014 R-%"-W5 FRONT ZONING SOPERVISC P. rLAN_< ---- _ - '.c MANGROVE COUNTER REVIEW REVIEW ifvEw IL REViEW DATE COMULETE