HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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3crding oro Cote 8ecuiavor Division
23OC ✓irginlc Ave,ue, For. P,erce FL 349&2
Phone, !?i21I52-1SS3 �ax_(772)^-52-1578
PERMIT APPLICATION FOR.
address
_e,�a Descripticn:
,per-, Tax Ip
Si -'e r!an Name. _
Building Permit Application
Commercial Residential
or-:ect Name.
Back: Righ Side:
S�Zbacks =ront
e!t Side.
Lot No _
Block No.
Additional wo FW�to-Fe—pertcirmed
under tnis perrrni - u�-
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_ Gas Tank
_ Gas PipingSorinkler�
_ Shutters
.�SNinddws/Dca�s
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_titechaeical
lip Code 3293-7 =ax:
321 %77- u23'a
6enerato;
Rcor
- mail
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Utilities:
_ Sewer _ Septic
Building Height
+eaess x�[-tee
'io ..ode.`--�
-,n No
-Mail
Sate
Fill in fee simple Title Holder on nett page ( if different
from the Owner listed above)
Name- ril L�-'
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Address- ihB �r»aw6
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: ,.�d-pan 3e>cv.
City b
State: t
lip Code 3293-7 =ax:
321 %77- u23'a
Phone No. -7 72 337-41g7
- mail
SLB i=. or Countt Llce ose�.'�✓I
rf value or construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNERI/ENGIN EER: _ Not Apphcable ! MORTGAGE COMPANY, _ Not Applicable
Name-. Name: _
Addressi Addre_s _
C:v'. State: Cirv: State-
7p Ph One. ZIP Phone,.
FEE SIMPLE TITLE HOLDER: _ NOE Apalicabie BONDING COMPANY: _Not Apollcable
Name: Name. _
',. Addres ._ -. Address. _
7i,n'. PhOO E'. Zip: ph•7^=
•ti iha, n;: ,ore cr ns a lar,o, s o mens crier Toth ssc :n _z c D e mrt.
Sr JC? Court', RIa Ke$ n0. pf Sen'Ctlon ha* i5_, It,t,, a rem al author :iv pe mT ioidei to oWlr :ne uc t-u r-Te
tS
wnicr Is 7 COnfIIG With any applfcablc Home Gwn : s ASSOCiat On rules. by WS or ana Out : th2 m y : e-t 1 JrOn'71 L'.G
deed for rest,icho s which may aDD,I
6 ,ucti e. Please consult with your Home OwnerS ASSOC•ct]On ar`c evie,, yoo any
. D2r'Orn LhE
!n co09Ge2i!Or DI the granting o` -his r e9ue Stec Bermtlt, l do hereby ='gree t-ar will, I all reso-Ct Swp(x
r. ccordancE with `-he apo Oved �lo'S e �IOrI Cc Eiuilding Coce5 -nd 51 Lucie COun-v '.ma'n rren.s.
,.
-he following b 'Iding perm , applica-'5 2re exe'1Di Prom undergoing a Buil corcurr9 cy evi2w: JOm d6ti0 n5:
accessory SfJiJ es, Swim' Ing Dods, fences waits signs. Scree roo-ns and 2CCesso:, 5 v- c,o h for-r e5 Oerria, 'Iia
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
A_ Notice of Commencement mrecorded and be recoand posted cn the;oosite
impents to your prone:-[y_
rovem
before t e fi;�st in 5peciicn. if yo,_ intend is obtain financing, cer.s'J;t w1V- lerder or er atlo-r^ey before
comrne worK Or record,.. year Notice Of Comme^ceme^,
t cam/
�•g12tJre Jf Owrleri Less _i Agenr
STATE OF FLQ+i^STATE OF FLOR
COUNTY OF `� OX-On 4CI COUNTY OF O �L
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Tile �j`rgcing in<<ue•=rt as =ck-ov::eae e=c=. -�_ he _ -� V
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"vd r'+e Gf dersOn cknes+'l?d E'nE) � (Name Of pefSCr' 'rc e Cknow!ECg,rS
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iSign aturE o�Nry b c State o Fier'da i �Vaur..N rya �l' ` rtorada
.e- ona7v xIcwl Cft Prcducee lD n i`i<ar:dn _ Per orally Krown. 04 Frocuce0
ol ce--,f c on Procicce4vPe of to510, fl-a(/r/��ori r -didijcc�/edd•
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.r=r"N.Notary Public Six hl
J>•' NN_otaiy_Public St to M E _ hilintan Irl.
Ashley M Antonelli My Commission G!
`d `• a My Commission GG 152970 ?a Expires
�! sed G i _� �i?V 14 �d� 10/181202
?ati
Expires 1011812021
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FRONT ZONING SUPERVISGR PLANS ! VEGE-A-,ON s UR-I_= MANGROVE
� COUNTER '. REVr_Vd REVIEW Re JIEW REVIEW REVIEW REVIEW
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