APPLICATION FOR BUILDING PERMIT Permit Fee CITY OF PENSACOLA Permit App. Fee Penalty Fee Radon Fee Plan Ck, Fee Plan & Zon, Fee Engineering Fee TOTAL Permit Zone = polos = ZOD { hereby make application fore permit to perform the work as described hersn and certify that all provisions ofthe law shal be compiled with whether specified or not wbasier [IS Ce Sh. Leal Description _OO $00 FOR O00 (693 cmiatee lasers Fuge nce Property Owner Be LEC Residential Dssigner aaa Commercial New Construction Fool Sim Tos! CostofConsinction — s_ AAC sddiion Remodel Deno 2 Bg Co Only (ens MEAS FenoeLis. Ft __Repirte Cade __ # ofstievteisht 2130. Sew Root Seca ceed Sa FUtiving Aes 2.025 Flood Zone BaseFod Et As Bait Tlood Plain: Appraised value of strctre Product Approval Menu Open Case Open Permits Comer Lor, City Assisted Projsis (Please check one) Covsc C seep Dorer Remarks eee Thereby declare thatthe site plan shows al existing building end structures on the ‘ocations with reference to lot lines ard to each other, and that all the information submitted herein is true and correct | understand that itis the owner's or contractor's responsibility to comply with State and Federal laws, rules regulations pertaining to notification and asbestos removal | procedures. fame (Pein er K Mo lay Name (I ) <9 or pH nena 4 Lf] suteticr — Doors, c C0. Comp. # ate RemarksBUILDING PERMIT APPLICATION owner's Name: 379 Z. dts PO. box 620 cry: fewsae le sw K_rip S264 ee Simple Titleholder’s Name (i other than owner) Contractor's Name: Mavee.U Deal fas wi Braves: 2355 Sonat Ad WSS EST cy. Peoturula Couny. Lteanb Site L- ob Name: Mallnae ld ha, 1 Adavess: City: State:__Zi Prasecda state: FZ _ rip S203 Legal Description: 00 Sos 4 08060098 Total Contract Price of Jobs 7262608 Bonding Company: Adidess: City State: ip AchiteevEngincer’s Name: iy State: Zip: ‘Mortgage Lender's Name: Adress: iy: State Zip: Application is hereby made to obtain @ permit to do the work and installations as indicated. 1 certify that no work or installation has ceomnmenced prior tothe issuanco of a permit and that al work willbe performed to moct the standards of all laws regulating cousteuetion inthis jurisdiction. I understand that a separete permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR-CONDITIONERS, ete, OWNER'S AFFIDAVIT: I certify tht all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning, WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR 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. ‘As applicant I promise in good faith that the statement provided by the Florida Department of Business and Professional Regulation ‘coneetting Florida's Construction Lien Law will be delivered to the person whose property is subject to attachment, wt Signatore: : L sit Signature: es _ ‘Domerlor Agent (agpeding conractor) Contactor Date LeLO“VE Date Lafel se? (Centticate of Competency Holder) ‘Contractor's State Certification/Registration No. Conteactor’s Centificate of Competency No: Dott S¥ ‘The foregoing instrument was acknowledged before me this ‘who is personally known to me or who has produced a ‘Wiliam 0, Wook, Notery Public State of Ford, an Wl bgDoriars State of Florida, Coumy of __ E-S¢ ty Gart (Notary Seat) as identification. “The foregoing instrument was acknowledged bofore me this LO coy oe ‘who is personally known to me or who bas produced a FLO 1s identification. \Witam 0, Wooks Notary Public- State of Fltida «Satin Bach 17 Nou sto Ove or Agat State of Florida, County of__ ESC 478) (Notary Seal) APPLICATION APPROVED BY (Pemit Office) _ZCZ a PERMIT NUMBER [2D 7-D/B-