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,CERTIFICATION: (;?
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, AND AIR CONDITIONERS, ETC., not otherwise included with this building permit
application.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
N, OTICE TO APPLICANT: AS THE APPLICANT FOR THIS BMDING PERMIT, IF IT IS NOT YOUR RIGHT, TITLE,
AND INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS
PERMIT YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED
CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT
TO ATTACHMENT.
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OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
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OWNER/CONTRACTOR SIGNATURE ONTRACTOR NATURE
STATE OF FLORID '� � STATE OF FLORIDA
0/v
COUNTY OF CYI-1-Y COUNTY OF A aa—ta
The foregoing ' s rument• s knowle4od The foregoing ins ment w Wacknledre me thi d o 2gby b fore me this y ofa5by
+ / who is personally who is personally
k own to me or o has prod known t e or who ha roduced
S iden ifica ' as identification.
I
igna o N ry ) i' Si ature of otary
Type of P(mt Name of N t - Typ or rint ame o Notary
�Y pU 0 RCIAL NOTARY SEAL -- --•-- -
�P 6� THRYN D MATTHEWS aY p/(�� OFFICIAL NOTARY SEAL
commission No. o eKal, gam1SS1t Nt6THRYN D MATTHEWS eal)
qZ COMMISSION NUMBER
' Q 051 l �i ri COMMISSION NUMBER
NOTE: TWO (2) l�yj I� N�*I4§I NATURE MUST BE NOT F PPLYI111�TM1rHIS B LING PERMIT AS
E
AN OWNER i1II HE OWF�i,VWSPERS NALLX APPEAR TO SIG �IISPQiA'I�PW1riFRC LISTED ON THE
FRONT OF HE�i�P A AT-IO . OF f APR. 21,2006 _ s
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1 OFI+'TCE USE ONLY
ZONIi�TG . .
SECTION
TOWNSHIP
RANGE
MAP NO.
J�
ZOI ING
P-5 1—f
LAND USE
LOT CVG %
Additional
Permits
Yes
no
.REPORT
ODE
BIMS FEE!
MISC FEES
TOTAL FEES
BUILDING .& ZONING REVIEW'
REVIEWS
ZONING
ZONING
PLANS
MISC.
VEGETATION
REVIEWED BY
EX4MING
DATE
+Q
COMPLETE
i
/
INITIALS
x
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