HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE JNFO MUST BE COMPLETED FOR APPLICATION Tij BE A=F{TF-D
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Building Permit Application
FY4r3rririg and 0EwJVm
8u0drnej and Code r�eguturi n LMsoGrt
7 00 Wrgrr7ia Awnut Fort fierce 34982
Phone: 172) 462-1553 Fax: (772 ) 462-9578
PERET TYPE:
PRapos ED IMPROVEMENT LO A-J1 47
Address;
Property Tax IDS'.
Site Plan Name:
profit Name:
D Ti AELED ID ESCRC PTio r.4 OF WO RK=
,-Ij
I XSTRU C ION a NFQ RMATE0N;.
Commercial — Residential
Additigri of wGr:k to be porion-led under this permit - 6i,-Ck all that apply--
_rvechanfcal
ZEiecuic
Total 5q_ Ft of on,,*rLictian7.
G;as Tank
PLumbing
Gar, pI pinf
—, SpriTtkler-,
Cost of 0anstructiom. � —
B
$butt&r5
Generator _Roof
Sq- fit_ of First FIcKn'
utilitl cs: Sevver _ optic Bu 4di nj�
OwNt kit �_&WF I v _ I Oi117 RAT R=
Na
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AOdress: ti � r w )r
Zip C 1 Fax-. IV City: r
PhorEe Na_ �� — �P co&& 'f r Fax:
E-Mail: Nn
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niii in fm srrrpLe Titld2 Holder -Ort n ei t pag-e ( if different E-Marl Nn Cd
front the Ovm ce Listed above) State or Comity 11<en sq a
L. armo a IiFJC RaF.€} NoticeNE±n ri5^ rft is rEW Fd!4-
Gt value Qf cq"sErueLirafe Is r'Sr
IF wahse of +TVAE is $7 -or mom, a RE(;QFtd€D Pdotice of C43nMeTWAWMffA iS requ iredL
NO
* No- S3-
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as __]L
SUPAEMENTAL CONSTRUCTIOM L16M SAW lidMSMATION=
DESK-N EFL/t N Gi NEER:
Not Appkable
Name:
Addimss-
Aitm: = State;
Zip:
FEE 9MFtE WLE HOWER: T Not APOCOble
Nam,
Address
Cam_
Zip; Phow
ORTGAG E COMPANY:
Ni m,-: _
Address: _
City; _
Z-p _ hone;
I �JNDING COL'1+9PANY= -- _
Adpdresv:
Applica ble
AppiicabW
t--._ -•
OWNER/ 0DWRAC OR AFFIDVIT= ADplica#i:an �;hecEbv made to oMin a permit tv d* the work and ins aLlatian as indi=ted.
1 certify that no uwod or nstalIatii)n Teas cammencE4j 01io r to the issuarice of a permit,
5t I u d e Gwr�j' mnk�s no r�pres'enitetuurl is- j�ntiv, a premit w i I a{u..t+huA a Cite �rmit facddtr to budd this 52rutti-IH
whkh is in conliict with a� j appfivablc Fi*� Others Assvclation rules. b law M Gr srrd ryvenan# that maY remit Ck r praf�ibit such
s#r�,ct Please Gpn"31 with your Hume 0�eM A�ssodatlon and F&.View YOU dt#�d list any rest•icknne which aV alaPt�-
I n comideration cLf the gr4njisV_ of Tbi:% requested pearl#, L do hereby vgv that I will, in *4I r ects, perform a work
in accordance vw3kt thr< approved pLaar,, Lhe Florida Huildinp, r.0deA and St i_udit County Amendmtr4-
rid €ollnwing buildirk� pofirth appliraticw5 are -cxemPt from unGk'r*?,0iri9 a fall cvmturreney rEview; rQodrl addrt
ancessor� strvCku rr% &WiMrBiT�g puolx, frraops, walis, signs, screen rooms and ?rtXF550Tv uses t0 $noMer non-F
°WAR WC TO OWNER: 1rMW FA R-URE TO p1ECORD Al NOTICE OF COMMFlMICEMOff MAY RESIU
TWICE FOR WROviErA 1Ts ra YOUR :PMFEVrT. A NOTICE OAF CDMU11ENC E MENT Wj5T
POSTED ON THE JOB SITE 9EMRE THE FIRST INS,i'1<CMAL OF YOU W11MB TO ORTAI fr
WrrH ToLtR LEMOt OR ALN ATTURNEr BUORE REtORD@yC 1fMit MYME OF COMM101CM-
o<� L'essee{r ax, Ft o wn rtt�ecbogdLic�, ter FF��CI r
i STATE OF FLORI ESA STATE OF FLORIDA
COU NTY OF ' j COUNTY OF
Tiic forgoing instrument wj)s $cknovrJedged Wore me
tfYlS `daY of x 5 by
- L'j • k
Name -of person making. star-ement.
F'ersanaliy L;Ytmn ._,.Z OR Produced Idendfication
TYpc �)f ld-rntifrca4on
PlOdUCE d
akMr nIa G�c• tp
JEAN AMICS V VXTQ
ff C3rmlecn 0 GG 2d41
' MMC—M Elpirc%DK 13.
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REVIEWS I COL NTT I � 1 R�
DATE
RECEWED
DATE
COMPLETED
The forgoing insuur"pt was
thiS
goal use
N YOUR PAY PiG
jZF1rjDR11ED AND
.AiCING, CONSULT
N
before mffl
• in
• "7 r
Na me of perSEM mai ur;g Statement_
f
persona9ly Known _ OR Produced if entificalfickn
I yrpe of ldentjH a�ion
Prod
.T-_-,
of Noteryr Public- 51ati� of
'MROxldS VEGETATION I SEA'fUU
REVIEW RIVIIEW -REVIEW
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Wy Public - StAe at P
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REVIEW