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
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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
RemarksBUILDING 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-