HomeMy WebLinkAboutBuilding Permit Application 04/27/2016 16:06 7724663737 BOYLEAC PAGE 01
ALLAPPLICASL INF PP
MUST BE COMIRMID FOR AUCATION TO BE AMPTED
Date' Permit Number: I6 O� O 5 al
CEIU`D APR 272016
Building Permit Application
Planning and&-mlopnient S4rvkcs
pudding and Code ReguhWw Dhdslon
23W lllrglWu Avenue,rea Pirwe FL 34S&2
Phone:(772)462-155 fax:(772)462-157 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of One v C
PROPOSED IMPROVEMENT LOCATION:
Address: Z.11 0 ENS
Lege)Description:
Property Tax in#: E !�. �� ! `�.�� o.�; _.. Lot No.3.Zx
Site Plan Name: Block No.
Project Name-.,. pi�1 e ( 1�1f1�i . f'/1U�irc_
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
3.5 r i� eek hnoK
Ip 1��1
CONSTRYCTION 114FORMATION:
AddltloRdl work 0arms Under s perm —check a apply.
HVAC 13 Gas Tankas Piping _shutters ElWindows/Doors
Electric Q Plumbing Sprinklers Generator 13 Roof
Total Sq.ft of Construction: ft.of First Floor.
Cost of Construction:$ 00 Utilitiest Sewer IJ Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name: *�
Address: Company:
City: State:F1, Address:
Zip Code: 3140(!51 Fax: f City:Q{ . _
A r w State.-A
Phone No. - Zip Code: 10,51 Fax: _7 7L SII®(a
E-Mall• Phone No. 2
Fill In fee simple Tilde Molder on nut page(ff different E-mail:
from the Owner listed above) State or County License: CAC 1$1900
H value of aonsttuctlon is$2500 or m*M a RECORDED Noon of CommenemaK Is n quIrRd.
04/27/2016 16:15 7724663737 BOYLEAC PAGE 01
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PPLEMENTAL.CONSTRUCTION UEN LAW INFORMATION:
NotApplica a moRTI: w GONIPANY: Nat Applicable
me• Name•
ddress: Address:
state City: ...�.,.^
Zip: Phone: Zip: Phone•
FEE SIMPLE Tilt 1E HmDER: .__.Not Applicable SONDiNG COMPANY: Not AppIkvblb
Name: Name:
Address: Addresw
CIW. --
Zip: Phone: 2W. r Phone:
I e ffft that no wort or Iroulladon has wmmm ed prior to the morem of a pm t.wrh is��� �� Horn s As� anrt��i kh ngY��structure. am your ome Owners Assodrtlan and your
In acconbrice with the net plaarida addrss Was hand St Lude m Owt laauntV"MWP the work
The followft h dWg p aWkadions am,, -Mjptfrom undo yft a fuH umauTencV revinew.reo+n addltloM
accMD1V structures,,admmbW pank fences.wags,dgn%screen rooms ora!armssory uses to wwom nwwaddmW use
WARNM To OWNER:Yoitr tWkm to Retard a Notice of Ca>>rstteftgirnertt nIN"N*In your 113ft trddr for
impmmnents to Hour _ rty.A Notice of Commencement must be recorded and posted on the pft
before the first ins If tie
you intend to obtain finandn&ooasult with lender or an attomey bef6re
cornmencins wort or vecorft your Notice of Commencement.
SWumn of Own �-n
DA
STATEOFFMOA
STATE OF �CDuNYOF --- COUNX OF— =.I&
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The lost mer¢ admowl�be�re me The forgatrrg ne, was�.�rbelbre no
by
this of m d9 this h'dh►of T lir ow
�Mrc BoyNAM r 5041e,
(Nance of person udcnerwle fti 6 l (Narrffi of person ).
75i—re of of Florida l (Stl wwre of NcmrY bL- roe of Horift)
Persoesey Known OR Produced ldentfcaaon many iuro�rn aR Produced Ide rafftc tion
Type of tdermncation Type of Idar>fl tow Produced
cammksinn No. Y CHRIRWWIX
ONW Gomrn�iarr�, RQM
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'Nq MMEtONI0 aiNY CXMS ust 2l.2Nb
abtOtBS •°01R ,
Revised 07115 �nswo+te
RPAPAM FROM 70NING SUPERVWR PIANS VEMATION SFATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW Rk1if�W
W1TE
COMPLETE
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