HomeMy WebLinkAboutBuilding Permit Application back sigature page r
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Df. 1GNER(l.NGtIER 'Not:Applictle MOlt7GA5E: MPANY .. . NttplKical<r1e'
'Native,`.ew�o�ruWse '
Name
Address s±Tcocvrurave .. .. ..
/ !dress'
Ctty, ssus. State : Cttjl
r a PFYcne::mz�zaryzsa gip:: Pltnnea.
F SIIPI. TITL .HOLDER _Ndt Appticab(e: . BlMDIN t~AMPAIIF: _t�Qt:aptfitcabl±
1�dd ress. . ... .. Address;
City Ctty�"
MO.ne> rp Phone:
t certJWthat:no'work.or ins6t!�ijon hastommented:pnor to.the issuance of aperrrk-
5t.t acre Coon�_y'rtrakes rrn representatroi that r grant[ng2 permitwrQ authonte th'e erm holderto burld'the snbjitstnicture..,.
which rs in confffct with any,applicable Home�wnersAssacratron;rules byCaws or and cavenartts that may restrict or p40hi6I suet!
strticfure Pleaseonsalt�nrithoelr Hc�meAwrters Association and revt�evir yorlr died farar(y resirJEtions which trtay apply:
to corisdecatrorjoftKe granting ofthrs requested'pernt►t,t do hereby agree that[will rid allrespects,perform.the work:
naccgdance with ttie:approved plans,the Florida Building Codesand SL,Lucte County Arpendments:
Thefollowing building-pemut appl cationsare.exempffrom undergoing a-fulC coneurrency review room additions;
accessory siructtires;"izmming.:paols„fences,W0.0.signs screen roomS:and acre Sory uses t+�mother sari-res►cipni rat
WARNING TOVIINER.~Yot+rfa�tur to tCard a Notaceof'Comrner�cemni mail-resultsln yararPa�naB twtpe for
impraventents to your proberty AN o Commencement must tae recorded and posted on a job's e.
before the ftrs> tnspectton..F uot�Intend to obtain financing,cdnsaft:w�th[ender ear an akorney tefdre
comrrienc�n wo,r�C a'r recorclln our tcit�ce of Commertceri�ent
_ _, 'Sr „attire of Cu" ctor Cr
_SrgnatureofQ�ntnerf LesseefAgent �. .: .,. ,!!�.. ,/ censeHolder -
:SrTATE OF EI,OWDA., ;STATE Op dRID-A...
The.forgoing Instrument was ac(inowledged befare",nte The forgoing instrument was a tknowledge,.before rise
this day of 17?i4�2cFf`. 2Q?�by this
rz�/,t� LYE �3�1�-►�� .�,l. .����
(Name`of person acknowledging::) (Name of person acicnowledgirrg•,};
'..Al
aw
(S,rgnature of f�C. . Public Slate of F..foritla<j (Signature of:Na ubhc ........ofFlorida.}.
Personally Known OR Eroduced;IdentiflCatron Persodallir(mown OR Produced:ldentificatron
Type of identifcatron.Produced. Type."qf tdent Catlotl Produced ......
IqN Commission No.
.Commission No: DOR p
0
� MYCOMbEISS[o'1#Fjili045445 k.WWI SStoutwi id5443..
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.�jryoFP •BQild2'��1[i1 ' ;!' rIC �: PL IS
Revised.l 1Sf
REVIEWS FRONT ZONING JSUPEAVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVJEW RE1/t.EW RE1lIEVi. REVIEW REVIEW R€VIEl!!t'
DATE
COMPLETE
tly117,4I5