HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr< H APPEECA INFO T49 7 BE COMPLETED FOR ARpI.FATPON M BE ACCEPTED
Date: 0 i. Purmil Number_
Building Permit App l icatio 1
Fanning aa-d &9v6apvn&3r Services
au i; vnd Cow, urarrm Dfv
2_[X] Verginia Avenue, Fort FE F4992
PhmT - (772) 462-1553 Fax: j 4Ei?-I57,3
Corn r ner-cial
CBDG Funding
Ridentia I
P E R MIT APPLICATION FO R; --
I P{ROP0SED } P-VEM—F-NF W TION:
Address:
Property Tax ID # - G
bite Pfau Name:
Proj«L Name:
DETAILED DESCWTION OF WORK:
Afevr Eleddiml :Mfater
Second EIemicai Metre
} CC NSTRUC 10 N I N FORMATION;
Additional work to be perform, ad under dik permi#— check an that appiwL
{Aff-u3,a•Y i requirec:l
Block Na m
_WX:F aniicai —Gas Tanis — C33s Pipin _ Shutters _ Wi rt&rws/ Door s _Pond
/11luctric _ Plumbing _ SPRipl, a'N i3ererator Ruud EiL4:h
Tatal 5q_ Ft Of COrknMC60TE
Cost of Conic#ion: $
1O6 00
5q_ FE_ of Firs! "-]ox}F_
Utilities: _ 5ewur — Septic Building Height:
Lace:
ZIP Code: _.._ Fax:
Phone No, E-
FVEaiI:-- •-
Fill in fee simo� ! Title HoWer -an next page {if doerera
#ruin the Owner lined above}
Na m E,: - - - ._...- r
Company: :1A
City:
Zip Code: M Fax: _ •
State or Cwnty License
If vaWe of construction is 2WO or more, a RECORDED ISE lke of Corrnnenrenvni is requFred_ -
M %Wue of HAVC is S7r5W or morr, a BECORDE) Native of Eomm,erxemerrt is required.
E?E5IGN f E E l 1 EER= Not Appl ica bye M RTCA E COPJLPMY: Nit A 110-a ble
Na me
Address_
City;
Zip, Phone
FEE SIMPLE TITLE HOLDER: � Ncrt App licab6e
Ka me,
Address;
Cit :
Zi p; _ Phonp�
PP
Na me,
Addre.%,v
City- State:
Zip:� Phone
BONDING COMPANY:
Marna:
Address: -
ZiP. P1=
_Not Applicable
OWNER/ CONTRACTOR r4FFtD iT: A Ncation is hereby made to obtWn * perrWt ko dv the w•orkanit insta®at cm as Mdk tad_
i twti€yr that rw work c r instal�atbn has mmmetzoM prior to the issuance of a permt
Sr- Luoe Counter makes no repre�errtmiim that es rantin a perm t will autharke the permit h00er tv build the sub*t mucture
rrf which c43Kls with �Iuppi abic Hun euwnersAsso�ia�on rules, byLa4 or arpd w%mznants U at may, restrict or prohibit such
strueEur , P(� cares t with your Homeowner.s odarion arW reuww your deed far any restrictions which + sppL�.
-wr*ideration of the granting of this requwstPO prrr:rit, I Rio herebw agree that I well, in all' respem, pprf *em theT work
in accordance with the appdWyeA plans, the Florida Building Codes and st. L �-OUr+ty AmRndments�
he #M1c,%veng building permit appikatiorrs are. ~. -mpt burn un-dea;oi rig a full concurrenW review: room a nions,•
ao: eEmaq =7iCt].Ires, &wimN-dip, pr y FerKes, walls, signs, screen rooms SrA a ir* uscn� ko another son -residential use
WARM N G TO OWNER. Four fa�fur4� to Rewrd a NoVce of CGmMencer and rMy result in Paying twice for
i mprOUffne ltS to your p r*petty,,, A N otice of Cam t noamEnt mvst be recorded i n the publ c records Of St,
Lux;,e County and posted arL the jobsita- before the f first i nspection. If you intend tv o btain fins nci ng, co nsuft
with ienvde r n r a n a `torn-y before comme icing work or recardi ng your N ti-ce of Co m mencl!nkent_
=-C)F
erf 1�s antrafrw AgentforCh�.re 1
RI'DA
UNTY OF '�P LICAe.'
Sw4arn tia ' r #r1ii�l and su sC3lbed. before nl a of ZP skat Pceser�r_e or C RIMe NOT21i2 of iaS7
this .ay cf 5 .. - by
NaFne of person making s rr�n#.
I r
Pero Known mt' Ft Juced Id ntifimtion
Tel I ntilicaRion P'Todured
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4 i
r�' �df Notary F1u'Sk-, Static mf F]andaj
,114fjn No. � i eaII
R'EViEws FRONT
COUNTER
DATE
RECEIVE
DATE --
EC MPLETED
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