HomeMy WebLinkAboutBuilding Permit Application (2)WTALADEIMMUMON UEN LAW MRMAT[C#N_
WGINEER; __-Not Applicable N=TGA6ECAI pAAtY_ _Not Applicable
Name:
Address:
State: City: State:
Phone Tip: Phone:
THE fRi8 XR-z Not Applicable BONDING COMPANY: blot Applicable
Address:
Zip: Phone:
as . �. .: .v. . r-.
.♦ rra .- ca r. . s-
_.
�Pieasseonsultwtiiuyuu+rHome Owners Association and revtunsryour dead for any restrictions may a _
',eration of the granting o€tbis requested permit I do hereby agree that I wilt, in all respects, perform the work
lance with -di e appromd 0ans,the Florida &M din g ffsdes and St. iucueCounty Amendments.
wing building permit applications are exempt from undergoing a full coocurrency review•. room additions,
y structures, swimming pools, fences, wad signs, screen rooms and accessory use to another norm dentiat use
ING TO OWNERr Yourfailtsae to Record a Notice of COMMOMM180t may resarli: in Voter paying twice for
ementsto your property_ A Notice of Commencement must be recorded and posted on the jobsite
he first Inspection. If you intend to obtain financing, consult with lender or an attorney before
Signature Oi Owner/ tS±Ss£e)%OntraCtQF Ageot fOP WnC'r
Signature of Contractor%I.ucerm Holder
STAn OF FLOMA.
�-
SPATE OF FLORIDA
CO INTY OF t +u ^�
COUNTY -OF
The fo oing insirumentwas acknowledged before me
Theforgoing instrumetn was acknowledged before me
this I( t4 day NOV 20? by
this ll day of WOV', 20-1-0 by
of
WW F
Midud F y1
Name of person ternertt
Name of pers lung sta meat
Personally Known OR Pmduced. identification
Persona4ly Known OR Produced Identiitcation
Type of identification
Type of Identification
Produced
Produced
6��
&4—nz(-a 2, 41"6vGG
{Signature of Notary fic-State of Florida)
}Sigaatureef Notary ic State of Florida }
Commission No, "' �ya.,.,iNE JOYCE CONWELL
Florida
CommiSSIon No, TINE JOYC LL
='g 4;'; Notary Pu_k SUte of
Commission 5 GG 484701
s%��'`.
_ :-`$;? Notary Puoiit Sta[e of Florida
Commission tl GG 04167
rem. Tres Au 21, 2024
_
Donded throul
i National Notary Asir
,
d
'
ou h National Not
Y Assn.
REVIEWS
FRO91
PMS
ROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
HATE
COMPLETED
Rev. 8/2/17