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HomeMy WebLinkAboutBuilding Permit Application ALLA[HICABLEINFO M 2 COMAFoMMcAMN ED BEAD Date: Permit Number: RECEIVE® • 1 BMMI M' " M } i 55' u NOV 18 2016 I I I Phone: (772)462-1553 Fax: (772)462-1578 Commercial Fbsidential PEWITAPR-ICATON FOR To Select from dropbox, click arrow at the end of line PROROM:)IM PROVEN EMT LOCATION: _. Address: v)Y06 ©A14 A gilile, gkt PieAce, F/ Y 9Yf Legal Description: �Gy {�� OF bAt OL 36ya -67, 7,-). 309-1p&r, Property Tax ID#: 0 0 © Lot No. -Ste Plan Name: 01-0— AkL vel Block No. Project Name: GJAC QA44,0 %tbacks Front Back: Fight Sde: Left Sde: FbEFAILE)DELI PTION QFWORK 00NSr JCIION INFOMAK ION: AdditionalworKtOpenerformed under this perms —check all appy: HVAC Gas Tank []Gas Piping _Siutters ❑Windows(Doors Bectric El Plumbing ❑Sprinklers Generator ❑ Fbof Roof pitch Total E�. R of Construction: Sq. R.of First Roor: Cost of Construction:$ doo. 019 Utilities Sewer 0 SO ptic Building Height: OWNB:�I 00NT FACTOR NaName: fFr o Address: L Q Company: Flh Ap" h•o GI(cCM,L aty: ,o ji cf- gate:f�`1_ Address: _d l L Zp Code: -3 Fax: aty: tlefo MAIL aatel;4 Phone No. 221, „Cd I y Op Code: ?2,qG l Fax 772, .361-O 1, E-Mail: Phone No. 7) Z S GZ70 K Ffflt � n 6 I E-Mail: 2/4@ , e.lecgl c, cv� ffMhl sWE Nate or County License:FCL1L-()2)3f2- I - - ' I -5 11 III � 1 �• S M i ®IY y' I 1 1'1 5� . I .1 .. •4 6V f aJPPL8\A ENTAL OONSTR JCTI ON U EN LAW I NFORMAT ON: D �' GIN 211'I Not Applicable MONUAGEODMIENMO Not Applicable Name: Name: Address: Address. City. State: City: tate: Zip: Phone: Zip: Phone: FE IN 10-= HoLDELHU Not Applicable BONDING 00M IWNLTM Not Applicable Name: Name: Address: Address: City: aty: Zip: Phone: Zp: Phone: I certify that no work or installation has commenced prior to the issuance of a permit. R.Wde(buntymakes no representation that is granting apermit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home OwnerSAssooatlon rules,bylaws or and covenantsthat may restrict or prohibit such structure.Please consult with your Home OwnersAssociation and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work in accordance with the approved plans,the Rorida Building Codes and a.Lude County Amendments. Thefollowing building permit applications are exempt from undergoing afull concurrency review:room additions, accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory usesto another non-residential use E E' �1 't yy E• 11' E E' E- WIT M)I 1 F J E J Ea cE I ` E' f WACl�ING�OWN 2 3 .•i•.' 3 5' I' M1 YI NIMIN �' •1 Sl �•J i• 51 Sl 6 •I✓• 25I�� I ' 6� I r improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or reoordin-q vour Notice of Commencement. 41 l4nalture of Owner p 1 ;Is Signature of Contr—add0tti5ense HoldeLE FLOMA coMLM _ COMMF The forgoing instrument w acknowledged before m R The forgoing instrument was acknowledged before me � ~` thislEdayof �/ �/(by �„� this�dayof A/ fV- 29 g N, a M54 A-03 t7 M9Q �Ob�T T� 0 2 m � (Name of person acknowledging) (Name of person acknowledging) o (Signature of N y Public-State of Ronda) U (Signature of Not blip-gate of Florida) N Personally Known OR Produce Identificat�'Ion Personally Known ORPrluted Iden ification Type of Identification Produced7 cZ7 Typeof Identification Produced C . Commission No. (Seal) Commission No. (Sial) Revised 07/15/2014 REVIEWS FRONT ZONING SJPau8OR PLANS VEGEfAMON EFATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEIIV DATE ocimmim INIUkM