HomeMy WebLinkAboutBuilding Permit ApplicationEN LAW INFORMATION:
SUPPLEMENTAL CONSTRUCTION LI7.
`DESIGNER/ENGINEER: ., . Not A liable
-- PP
MORTGAGE COMPANY, _ Not App licable .
--
am
Ne:
Name
Address
Address
-
PhonState . :City
e' ."
Zlp, -Phone•,
2
:FEE-SIMPLE;TITLE HOLDER: _ NOt''Applicable -
u,
BONDING COMPANY: �Not;Applcable
Name:
-
Name:
Address -
-:City
_
Address
_ _
Ci
ZI one Phfi
P'
_
_ ...,
OWNER/CONTRACTOR AFFIDVRC-Applicetlon ' Hereby made to obtain a permit to do the work and installetton asandicated.
it.:
I'certlfy that no'work or nstallaflon has ommericed pno� to,theassuance of:a permAt
:.:
--- —.: :.. '. .,�
POSTED ON THE JOB SRE BEfFQRE TILE FIRST NIM
•w�w.c 71C ;�VIIRgiiRi�Gf�■ ;�Yi■ OC RCWIQ/CY;;AtW..,
C� m IF YOU lIIiEMD OBTAMI: FIIIAMCMMC, OIIIStJLT
Y A7IORNEYBEFO'RE .:.
,Y MEiY'
Si ature of Owner/ Lessee/Contractor,as Agent for-, weer
Signature of Contractor/Ucense Holder:
STATE OF FLORIDA Co '0*n ,�6
:CpUNTY OF= S`f it 6A
STATE OF ft9R18A �ei'a,,rlj
_
3
. - :
000NTY
The fo rts instrum ,, was acknowledged before me '
ahis.L ay of . r7rT' 20 70 by
The fo ' oing tns, m ° nt was acknowledged before me
this day of . v 20 �D by
Name of person:making-tatement.
Name of person making statement . '
Personally Known V,_ OR Producedadentiflcation .
Personally Know OR Produced itlentfficaticn.
Type of'Ideritification
Produced , .y MARK ANOREW BONNEMA
-of IdentiHcat on -
MARK ANUREW>BON
Produced NEMA
Y.PUDUC
STATE:OF COLQNAWp
_ PUDUC
SOLORADO
.. NOTARYID;20184039034 ,,:
AIYCO
NOTARYID 20184039034,
COMNISSIOM 4(PIHES_0CT08ER:& 0 ..:
(Signaturee of Notary P.0 is a, _
`(SlgnatWre of Notary Public state of Fla lda ),
Commisslon N0Olg4o3go3y (Sea1j'
Commi3sion No. Zola �103903�/" sea
- . it
REVIEWS
FRONT
;ZONING
SUPERVISOR
PLANS
VEGETATION ,SEA
TURTLE,
MANGROVE; ;
,.COUNTER
:REVIEW _.N.,
REVIEW
:REVIEW
REVIEW:
REVIEW
REVIEW `
DATE ,....
RECEIVED
_
-
-
..DATE
-
COMPLETED
ev..