HomeMy WebLinkAboutBuilding Permit Application ALL AL�CA, t;INFO MAST BE CIUMPMED FM AP MOD]TO BE ACCEM-00
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PERM3TC APPi�.CATION FOR'- 'Tb Select frofn dPopbm, dick wc wat tba and o?Un.e
9lcpcsz��3,°' OCA?34
Addr
G-n\ ADA'St.WOWS W52
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site Plan N;ama: Block no.
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�s F✓s,3�i~� g -'�;��-sem s .'°}e Qit� `y�'''"
L� � t: .-le�:,..� �400`',vsf�'•:'r::'i?5.:E::'6w'_' �. bs' n6�:. 3
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undertnis permit—L! ecR au'g"'-
apply
Wile Gas Tank rPiping0 �ilaai tits Ifirth 1ows{®€aars
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Teal.a9.Ps IOFC0 UIt'7'O= f L�RiRoot:
c¢asz¢ry co>ra $ "'� �a 0i laS ,� t�;e is.� .Selyd� i13`t 3��i9a
� a.k.TL'ir•_.... "i'ass'�''ia�.mS, { a..,.1i s �..Z C;• R.
ijamelIt # G a=Mara aa�a�: sl s L `s �rWnna
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M,Porl State,—
F=772-878-OM4
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! ' F"aEn iF.-av a,,Ols VISS3--ederon n page w rwiv, I E-�€elh
t it4"value 0!C 11-4-3II o a9$25n wr gnW&,a i3ic7Ev AOnxf"V rWrarr,Cncz3r.enT
NotApp{icable MDR—S GPCOMPNNW: �NotRpplicable
Nam. Nam.e� a
t dd�e5s: Address:
City: State City: State:
Zip: Phone: Zip: Phone:
E SIMPLE TIT LE HGIDID Jo ,,,._,Not Applicable SONDING. PA p Not Appileabte
Marne: Narne:
Address.- Address:
Caw
City:
zips:
Phone: Zip: Phone:
>;cerffy tinit no vrraark aurins Alla bn.vas cornmenc d priorto the imitonce of a pe l-
SE. csercotsrnasraorcarsen�a �issar�g ,er `ca�aaa�eeteermile� k� e� esaasectscare
as est et� aldec�nraa a app�3' � #�ar�aeraess .aciavt� a,es, ydavus ar era e�t� a� a�rr►ay�es�eice•orr� �� sueS�
s3tr�c¢aa�Please Conss8l� yaaor dttmse�tn���ssnr�a�ssa ��ir3e�+9 yt�o�r deed f$r�rs�res�e�rsrs Lvla;<�rsay ap3��1-
jp-corgdderaum cf he•gvanfts dais requested pgrarask,3 deo herebyagree-that8 ufrll,in all respec",piriform the work
in a ntdan `o e a slar d lases,alae J da Swiding Cades and st..Lude-countvAmeradmenfs
-rhe fel8ataft bifilds'ag pepn a-pplimigons a full concurrewi r rw:morns add0ops,
amessory s urlures,sc4n-.peels,van s,���lls,s"s�,.SCM-�n MOMS and OW2SWTV aasa5 to ager non-reddendai use
improvre encs to Your pfrope Afttk&of Commencement most be rearded and posted an the jobsite
before the first Inspection.if you intend to obtain financing,consult with lender or awatto ey before
coM.Me wex or recording yoqr.Matice of Comam ova emenlL
s
Sign ctor1 aceeise Holder
Thera koag i, enl vu acluoawletiged re Yleerfargait z i3osi wment nems aatcss Wedged befi)^+e nze
of �alyy
.QA�s�iryle tnyraxc it¢&it9t�t✓Ly:2 Wyreta
(Naane ast ilea s�n ackraowledg`7;;K/
j^ (Name of p?rson actvsowledgin .
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` attz3re mataT•} rc stmtc-sof aaada (S *ai of Notanr -ablle-she of Florida
Personatlyl(hom x OR PrO&CedUderwrafion pemmallyffnMM OR-Pro duced-ldes'ntTflca ion
Typeof Iden..."o l a®aati'� l�u� j
BYPO af➢dentMe a2fo r P,wdoaced
,, •CO€rarn'ss10v;NO- " corilmis. n 11142_
o` EXPIRES:FeDrusry 3, W�"►;►r• •*_ WCOWISSION'#GG 356204
u.F ;�;
•..QF 6..$P, Banded Thm Notary ,yOFF�pP,•
d i J•15 Banded ih v'Notary PuDtk Undetwrit�ia
C6UWM REVIEW REWIN REWEW :RKVIEW REVMAJ
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