HomeMy WebLinkAboutPLBD1502-0129-ApplicationContact Person:
Company Name
Business Address
City
City of Parkland
Building Permit Application
www.citvofoarkland.or
Phone #: c601- V25 -q� l
E-mail: Y1D11 4(, (\/1
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ALL OF THE FOLLOWING MUST BE FILLED IN BY APPLICANT, ACCORDING TO F.S. 713.135
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Phone #
Property Owner's Name;
Owner's Street Address as
one #
Job Site Address (o-n5NV'-12- Lot
1 Work Description:
1
Ifi Ct
Vic
Block
Master Peri/lit Number
nm
Date
Construction Value
Engineer's Name
Engineer's License #
Phone #
Architect's Name
Architect's License #
Phone #
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Application
1)
Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of permit
and that all work will be performed to meet the standards of all laws regulating construction in the City of Parkland, Florida. I understand that a separate permit may be
secured for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, BOILERS, TANKS, AIR CONDITIONERS, ROOFING, SHUTTERS, ETC.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCMENT 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
Notification E-mail:
ntractor
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Printampf � i�/Bui � Ns
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Owner
License num
Signature of Qualifier:
On this IC/ day of , 20 (S before me, the undersigned
Notary Public of the State of Florida, personally appeared
and whose name is subscribed to and within
thein ment and he/she acknowl es tha he/shed it.
NQTF�RY PyBLIC, STATE OF FLORI
(LAI n so\n
PRINTED NAME OF NOTARY PUBLIC
❑ Personally known to me
❑ Oath taken
NOTARY PUBLIC SEAL OF
OFFICE:
Application Approved By:
Permit Officer
Q1
❑ Produced identification
O'Oetlt nottakceri '$ :'"''
MELANIE JOHNSON
Nff a i - State of Florida
F,Ir2^ 2015
Notification E-mail:
Print Name of Property Owner: i {
Fa 5i (ktY (i
Owner's Address:
(1-12-;1S— NN\J ('k L.t;--, Pat 11 � E -L
Signatu a of Property Oner: , t
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On this 4' )day of P34 -0j, 20 before me, the undersigned
Notary Public of the State of Florida, personally appeared
and whose name is subscribed to and within the
ins rument, and he/ ackn wledges that he/she executed it.
NOTAR PUBLIC, STATE LORIDA
Vkii eiQ J U •Q, Sa\\f &df
_SCE 1
PRINTED NAME OF NOTARY PUBLIC
❑ Personally known to me ❑ Produced identification
❑ Oath taken
NOTARY PUBLIC SEAL
OF OFFICE:
Date:
❑ Oath not taken
MELANIE JOHNSON
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Notary Sta:e
My ccsf; .. r.s '.r. 20, 20.5
L( rk :•sit:, n` F : 74567