HomeMy WebLinkAboutPermit ApplicationAIIAPPLICABLE INFO MUST BE COMPLETEO FOR APPLICATION IO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning ond Developnent Se ices
Buil.ling ond Code Reguldtion Division \
2300 VirgiDio Avenue, Fott Pierce fL 34982
Phoner {772) 462-1ss3 Fax: 1772) 462-157a Commercial Residential X
PERMTT rYPE: boi) cin - feic?-
PROPOSED IMPROVEMENT LOCATION:
Address:
Properw Tax lD#:
Site Plan Name:
LotNo._jgl
Blo.k No.
Project Nanre: Sdfe-
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit check
_ Gas Piping
sprinklers
allthat apply:
Mechanical Gas Tank shutters Windows/Doors
_ Electric _ Plumbing _ Generator _ Roof _ Pitch
Total sq. Ft of construction:Sq.
Utilities:L-r ^ oO
Cost of Co nsrru ct ion : 5 _s2r2!d_tr-Sewer _ Septic Building Heightl
lfvalue of construction is S2s00 or
lfvalue of HVAC is 57,500 or hore,
more, a RECORDED Notice of commencement is required.
a RECORDED Notke of commencement is required.
DETAILED DESCRIPTION OF WORK:
OWNER/LESSEE:CONTRACTOR:
Name
1..Address:
City:/4,State:l=1?
Zip Code:
Phoneuo. '272-)o,1 - 37/4
tttt":,lC@
Fillin teesimpleTitle Holder on next pa8e ( ifdifferenl
from the Owner listod above)
e,S
naaress:47O Ihartin RJ SE
aip code: 1!)QQQ-
8".1
State or County ticense
\_
ru
DESIGNER/ENGINEER:
-NotAppIicableName:
Address:
City:State:
zip'.Phone
MoRTGAGE COMPANY: _ Not Applicable
Name:
Address:
City:State:
Tipt Phone
FEE SIMPLE TITLE HOLDER:
-
Not Applicable
Name:
Address:
City:
Zip.Phone:
BONDING COMPANY: _Not Applicable
Nam
Add
City
Zipi
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to doth€ work and installation as indicated.
lcertifothat no workor installation has commenced prior to the issuance of a pe.mit.
h Lu.ie a.unlv makes no reoresentation that is Erantin! a oermit will authorize th e oermit holderto buiid thesubiect slructure
whi.h is in.onf idwkh anv iooh.able Home Owiers Asiociation rules. bvlaws or and covenanL rhal mav restrict 6r orohibir such
structure. Pleaieconsulr wirh iour HomeOwne.s Asso.iation and.eviewiour deedfor any restlictions vihich may apply.
ln €onsideration of the granting ofthas requested pemil I do hereby agree that lwlll, in allrespects, perform the work
in accordance with the approved plantthe Florida Bullding CodesandSt. Lu.ie County Amendm€nts.
Thefollowing buildinBpermit applicatiofls are exempt from unde€oing a full concurency .eview: room additions,
accessory structures, swimminS pools, fences, walk, signs, screen rooms and accessory uses to another non_residential use
"WARIIII{C .TO OWI{ER: YOUR TAIURE TO RECORD A I{OTICE OF }IAY RESULT III YOUR PAYII\IC
TWICE FOR I PROYE ETITS TO YOUR PROPERTY. A I\IOTICE
POSTED OI{ T1IE JOB SITE BEFORE THE FIBS.T lilsPECIIOI\I. IF
OF COMiIEI{CE ENT iIUSI BE RECORDED AI\ID
YOU NTEND TO OBTAIII FII\IAIICII{G, COI{SULI
IY]TF YOUR LEiDER OR AN ATTORIIEY BEFORE RECORDI G OF
STATE OF FLORIDA
COUNTY OF RieV.yd
The foreoine insrrumenrwas aclnowledged be{ore me
thisaoay of APr il .2020 b{ /.^
Name ol person making statement.
Pe6onally Known )a oR Produ.ed I
Tvoe of lde.tif.ationp,.a'*a /l/A
of Notary Public State of
co ^E i"rNo. tbl72?
of Owner/ Lessee/Contractor as asent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrulnent was achowledged
Name of person making statement
Perso.aly (nown
-
oR Produced ldent
Type of ldentification
Public- State of rlorida )
commissionNo.-lAE27 ,
llJri;9E
Eq oER*
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,JOSEPH E. SMITH,
FrLE + 4698515
CLERK OF THX
oR rlooK 4408
CIRCUIT COURT - SAINT LUCIE COTJNTY
PAGE 23'77, Recolded 04/L5/2020 03:45:53 PM
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