HomeMy WebLinkAboutBuilding Permit ApplicationWARNING TO OWNER:
YOUR FAILURE TO RECORD A NOTICE OF
IMPROVEMENTS TO VOUR PROPERTY. A
POSTED ON THE JOB SITE BEFORE THE FI.
IF YOU INTEND TO OBTAIN FINANCING, 0
COMMENCING WORK OR RECORDING YO
Must be signed by own /Agent and applicant: j
(Signature orcontractor) �y
State of Florida, County of ; e.,
Affirmed to and subscribed before me this erg
13
2o,b Aust ,A
rsona y n to mc)or who has produced
as r entt ow
nation.
EMENT MAY RESULT IN YOUR PAYING TWICE FOR
COMMENCEMENT MUST BE RECORDED AND
WITH YOUR LENDER OR AN ATTORNEY BEFORE
ICE OF COMMENCEMENT. 1�
(Signature of Owaeror Agrra (including contractor))
State of Florida, County of tNv
Affirmed to and subscribed before me this -4 /
200, by rk
[personal tom or who has produced
ac Montirrati„n
Construction documents must accompany this application. The Florida energy code submitted becomes an integral part of this
plan and must pass final inspection. "Notice: In addition to the requirements of this permit, there may be additional restrictions
applicable to this property that may be found in the public record of this county, and there may be additional permits required
from other governmental entities such as waste management district, state agencies, or federal agencies. "SIGNATURE OF THE
APPLICANT MUST BE NOTARIZED. Ifowner builder, applicant must sign iri person. BUILDING PERMIT includes:
Building, Electrical, Plumbing, Mechanical, and Sewer only. All other trades require separate applications.
Asbestos compliance: It is the owner's or operator's responsibility to comply with section 469.003, Florida Statutes, and
to notify the Department of Environmental Protection of his or her intentions to remove asbestos, when applicable, in
accordance with state and federal law.
FEE SIMPLE TITLEHOLDER, BONDING COMPANY AND MORTGAGE LENDER INFORMATION IS REQUIRED WHEN
THE AGGREGATE VALUE (TOTAL COST OF ALL IMPROVEMENTS AND NOT JUST WORK AUTHORIZED BY THE
INDIVIDUAL PERMIT) IS 52500 OR MORE (EXCEPT HVAC REPAIRIREPL.ACEMENT<S7500). PLEASE ADDRESS ALL
ITE51S.
Fee Simple Tiaebotdet's
Name (if other than owner):
Addmr:
Mortgage Lender's
tiame:
Addreu:
City:
fir %me as Owner
State.. Tp:
Applicable
State: Zip:
Bonding Company
Nems:
Address:
City:
Z"ot" pliwble
Zip:
OFFICE USE ONLY
Is the property located in a Special Flood Hazard Area (floodplain) per the current Flood Insurance Rate Map (FIRM)
❑ Yes ❑ No
Flood Zone: Reviewed by: Determination:
Permit Fee S
State Surcharge S
Subcontractor S
Total Amount Due at Issuance
Remarks
Reviewed by
Other S Plan Review Fee
Other $ Routing Fee
Flood Review Fee S Other
Date Final Check
Active Code Violation 0 Yes 0 No
Case #
Case Type
Date
Page 2 of 2
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WO WJST BE CONI ETED FOR APPLICATION TO BE ACCEPTED
Permit Number:NNW _
•
Building Permit Application
.- a" aftel wort t Seer "s
ftsW"mdCa*ft9wW=Dosm
Z" 16 piiiiiiiiiii Amemie, Fort AnceR_U9&2
P!oo*- qn) 462-1553 Fait CM) 462-1578 Commercial Residential
PERMIT TYPE: (we_
PROPQSEDdI,MPROVEMENT LOCATION:
Acidrpss: �V- {1
�1
Proper, Tax * !f: _ U ` �7 - d ` J \ !yb0 " Lot No.
Site Pian Marne: Block No.
Project Mane:
' DETAILED DESCRIPTION OF WORK:
a o! Ilk 440v ve a •o ss . Awa",-
wa"-CONSTRUCTION
CONSTRUCTIONINFORMATION:
Addak nai work to be performed under this permit --- check all that apply: f�e�
— Mechanical _ Gas Tank a Gas Piping _ Shutters _ Windows/Doors
_ Electric Plumbing Sprinklers v Generator Roof _ Pitch
Total 5q. Ft of Construction: am Sq. Ft. of First Floor:
Cost Construction:; �g( utilities: Sewer Septic Building Height:
'OWNER/LESSEE:
CONTRACTOR:
Name. 1C1 +tom+►' __ _. �_�--
Name -1 -
Adtlress- Y"Ntr
Company: f 1 O
City. '( State: f:A,,,
Address:
Zip Code: MqAn Fax:
City: state:
phone fNo.
Zip Cade: 1110 (ncj Fax:
E -Mail:
Phone No I-11 a So � �g1
Fill in fere simple Title Hoklier on next p8p (If different
E -Mail baa i 1D.f � .
-3,9,7
from the Owner listed at�owe)
State or Count License -rd'
Y
tf value of construction is 525M of MOM, a tutu Rome or ti0mm6vmm3mn m reWry
ff valine of tfVAC is $7,5W of more, a RECORDED IMotite of Commencement Is required.
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