HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICA9LE INFOe MUSTBE COMPLETED FORAPPLICATION'TO BE ACCEPTED
Date: Permit Rumber!
LUJI, Uf E
-D
KIM tl RECEIVE
Buildift P(eft-it Application.
'd, 0 ev'" 1
Nonning.an , ebpmefitSer�ices
en 'tying 00679-and Code.'Regijladbn'Divislon commerd 4 .%Abe RP_rm
jai 11.0sidentia.1 ]ittln
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�POO V irgihiq,A0en.ufj F60 Pierte, fk, 34982
Phone-.,(.172) 46245153 FqX:(-7721,4_62,745-78
PERMITARPL[CATIGN, FOR:
4e. <, 1:5, 6 'k,
Address: -b
PropertyTax:1D.'#:_ Lot No.
;vd S�i '36'g Blot' , o.
Site Plan Nzirng'�;Oce&,, L�PA0106, Cdc);344+
Project Name:, W4A kW, A�t s 1".J'e
`New Elect rical Meter _,S,econd, ElectricaltMeter,
Additional work't6bei)erfc,irrh8d- underthis>perrnit—chec ka I If that apply.-.
.Mechanical: Gb-.Tahk, GasT1,01rig ,Shijt,ters WitildowlVD6cirs '—'Pond.
E . ledrit- Plumbing Sprinklers Generator_.Roof , Pitch
.Total, Sq. Ft. of Construction. 46 X 4 44440, A Sqjt,of Fliest'Fbor!
'Cost,of Cori structib n; $ Utilities: —Sewer _Septic Build ing'H eight:
T 3v
C
Name %rmo iN)
Name:. (.3 (AJA
Address: t 12JAL ffiev.,Aia)ke�s6
Company
Address:
City: 'State: P,
Zip Code: 5?1 41�Fax:
city.. St6te
Phone No. 614 1 07~Al 11
Zip Code: Fax:
Phone No
E-Mai 1,
Fill In feesinf0le%TitlLi Holder on:nekt,fJiage.(ifdifferent
E-Mall
State or County License
frorri'the Ownef listed, above)
lfvalue of cbnstrudibmis-2500 omorej a RECORDED NoticeoKorilmeticement is required..
If vaiue,of 'HAVC is $7,500" or more,'a RECORDED I DED Notice of . Commencement igrequirtd-
Add(gs';Add ress'
city:
Zip. tp-., 'Phone.
OWNER/ CO.NTRACTQR,.,AFF.IDVI.T,.:.A M : I it' I di 0040tibn,lkbot.6��.� A06-tQobtafn a;Oierffiitfoft the work an.d thstO L.. iowos,in, (cated.,
Coe that.'n-o w'-.0- k-or-ingt4flatibh hasto- mn'064 prior is—f a permit.
The4bllowi'ng,bdildi�hg p n qQnCq additions,,
cy
.. : -�Ces,;,.'ig:d's"-j, s'd'e_,&;n.;e'.qq�ls�and. aqces�or,V.jsdi-tj Aho,th0r,.fi0n swimming zrosidenti. al U,
WARNING TO,bWYEAYdurf ilyre, 'RecordaNOtteQfConrtiencement,m@yyRsqiTin paying twice for
e,
Signature as Agent o'r,OWnprS�ghgfbf Hblder
STATE OFFLOMA, ST AT E � OF FIO RID A'
COUNTTOF ?( L I tou TOF i3 -(2
S�xi n-to- (or aiffirmed):and subscribedbefore me of Sworn :;to,,(or -affi'rmed)d' -..and subscribed before
slFal P116 Notarizati
Phvs*cal Prose ep o Online Notarization R4 0sen.:m0,r. Online on
this.` day of b
Personally Known OR Produced,ldeliiifi6atidin
Ty pe of identification. , , ,
tommissidbNo..
REVIEWS
Name of person makipgastaiement.
lxeesdnatiy*"'qwn OR Produced identification-
Type.-Pf l. .Identification
-Cit'ion
Pr041d.c0d
�JOH (Signature of State ofTlorfdaj
S-V�PPYI�OR P!AM51, VEGETATIQN
REVIEV OEVI-M REW.M.