HomeMy WebLinkAboutBuilding permit appAil APPILLCABLIE INFO MM BE COMPLETED FOR APE}! fCATION TO BE ACCEPTEO
Date- — l Permit Nimbi er;
Building Permit Application
PeAnfrmg OrW Devrk rnen[ Servkes
fUi`dirrg orrd Code Regulatm a w%ioiq Commercial Residential
.21firginea AvmLbt Aarr Piefce rt 34982
Phone; R 772} 462,1S 5-� Fax_ (772) 2-1.�'379
PE R MET APPLICATION FOR,
PROPOSED 1WROVEM ENT LOCATION:
Address- I '�L C�
0
Pr(Ve ' Tax ID # _ _ '� - r y Lot No.
Sate Plan Name.: 8I Uo,
DETAILED 0 ESCA IPTION QF WORK:
C4
"�;-k
New Electrical Nlctcr
Second Electrical Meer
CONSTRUCTION INFORMATION_
dal "rk to b�-- performed under thL� permit— rhec* all that appN:
_Med)anlcal _ Gas Tank _ Gas I}i ping _ Strutters _ Wiindowsf [mars Pond
�ZElectiric _ Ptu tubing — 5pri rikler$ Generator Ecof Pitch
Tour Sq. Ft of ConAmction-
5q_ PL of First Fluor_ _
Cost of Construction- 5 (itilitie-s: _ Sewer _ Seoc: 1Bui0irig F�60t;
O NERI L ESSE E: CONTRACTOR:
Name - ... _� x �L Name: vi
Address; k b r Lx+ . pang;
City: � �• rt'��' State: 'CZ-L Address- !Vq14 ee 55 �v
`` .. �!ip Code; ' '{F Fax: )l.+ City:
Phone No. ..(C O I, L1 Fax-
E.-Ma i 1- Phone No ~? _ ` t' - 5 1.
F'11 in foe simple -rAle Holder on next page t rf differerrt E-MWI �+
i from the Owner listed above) State -or CountV liiDense �
If value -01 bimstruc04n i5 2500 or mo re, a REOMDED riatice of Carnmeme oeht is rrquircd
It value of FIAV[ is $705W Or rrX�rl�r ;l RECORDED f+Eatice cf Gommen€enw-rit is requ ire&
SUPPLEM ETAL CO NSTRUCTION LIEPl LAW INF•0RMATION:
DESIGN ERf ENG I NEER: _ N of P;pr I i�,a b le
Narne
Add ress= - —
CKY; � Stag:
Zip- phone
FEE SIMPLE TrrLS HOLOM, _ Not Applirabw
Nam,
Address: -
City: _
M p; Phone: —
MORTGAGE CGNIPAMY: Not AP PI i cable
Name;
Ad-d ress=
Cky-, state, _
Zip. Phone:
BONDING COMPANY: Nat Ap-pliable
Name: _
AJt3rU-,�:
City: —
P
Phone:
OWNER/ CONTRACTOR J-IFFEDVIT= Application i� hrr-cby made to obtain a permit to do the xwaA and instalhi&rt *s 6ri0icatcd.
I r?�rtity that n-D work or ire%tallutmn has commenced prior to Me ;i&umnce of a permit.
St. Lucie County maid no feve firatation that is granting $ A'crrnit will authorize dbe permit holder w build the subject structu re
which is in ear,Irici with o my applicable Home Qwn"5 A-sodation rules, b'VI'aws nr and Qownams that may restrict br prohi bit suer•.
structure. Picric consult with your Horne Owners A;sooation and review your dead for any restrictions whiff may apply.
In consideration of the g 4ntir% of 91 s requested perrrtk I do hereby agree that i will, sn 411 rc-spects, perform the wo€k
in accordance with tht Approved plans, the Frorid;� Building Codes and S& I utie f wntw Amendrnertts.-
The fallourliihutid ing permit applications err exempt ftm -undergn.ing rh full concurrencyr review= rnom addiliuns,
rcoemaryr strut urP.s, swirr mJnP. Fools, fences} waIIk signs, *utcn rooms and accessortia use ko mother Fran -residential use
WARN] NG TO OYMER. Your fv Pure W Remrd a Notice of ComFnencement may remit in payft twits for
improve ments to'+our property. A Notk* of Commence meet m ust ba rec4 rded in the public re❑Qrd's -of St.
Lucie County and ,tested on tha jub�5ite Before the f rst JrLsPectiion. If you intend to obta i n Ifl narrcing, corFsuh
w ith I ender or a r, atto rni , . b fore co r:n menc i n& work o r recofding ycrur Notice of Cbmmanceme rn,
SIFnut Owner{ t �= M WRTWOPmer natu roof ': �1"-dorf License Holder
CMF FE OF FLORIDA —� --
A E 0REVA
COUNTY 01ft COU IFFY OF .
Sw {or affirmed} and submcribEd bare me of
,Ptrysical Presence Qr _ Online Notarizstior,
this day of _ tea. �-¢ b'yr + j
Name of person rqa Staternent.
PersunWhi Known --�Z— OR PFoduced Idek
I VP P' Identification 1, f-F-V
:
[5� atUTe of Nctaryr Tubb 51a, a of PlorAa } ; Tz
� }
Ournmission No_ tsew) !� '*
�e ~
REMEW.S I FRONT I ?-ONJ NG
E UNTF R REVIEW
REEE IVE D
[SATE
CC] MiPLEnn
Sir p.#o Jor of c rned] and subsr� 1b d h+ef lFe me of
PhOcal Vi nce of Online nolariza#an
thisLt--fty of l'; �''r� 2020 b
Nance uf person making: iUk r
PersonanyfKnown R PNPduced iderotifkmfion
Tyre* of WenfificatioD
Produced P5]
(SiigratUre OfNutizry Pldbli2- Itateof florid;
No. _— (Seal ' .�
PLANS I VEGETATION I SEA TURTLE
REVIEW REVIEW R1 lEW