HomeMy WebLinkAboutMARTINEZ - PERMIT APPLICATIONAll APPLICABLE INFO yMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Bate: - -- - } 1 �''�7 Permit number:
Planning and Development Services
BuRding and Code Regulotlon bivls%n
2300 Vfryinra Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
� , 0,n� A- 1�
Building Permit Application u G '1t
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Commercial Residential
Address: fit_ �1 `', ���1 1�[1►-� '�.Yyl
Property Tax 1D #: L c3 D
Site Plan dame: -T) V\
Project Name: 41 �.� L ✓'�
;LA 11
Lot No. J
Block No.
Additional work to be performed under this permit -check all that apply:
_Mechanical �GasTank -'Cfa'sPiping —Shutters —Windows/Doors
_ Electric — Plumbing ,_ Sprinklers - . Generator — Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ S 1 Gl 13 , D utilities: —Sewer _ Septic , Building Height:
Addle 1 � � �\,-w Vb �l � L�._c�
City: Yb ti' 1 1 (,A C R.t_ staterE
Zip Code: Gl SJ Fax;
Phone No. P
E-Mail: tee 1"l`- v kyt-V V!
Fill In fee simple Title Holder on next page ( if different
from the owner listed above)
Name.LanY Licastri !
Ca mpany:AmeriGes i
Address:3301 Oleander Avenue
City: fort Pierce State: FL
Zip Code: 34982 Fax; 772-465-8448
'Phone N0772-633-0740
E-Mail AmiaOGas-7262@amedgas.com
State or County Ucensea2707128579
if value -f construction is $25ao or more, a RECORDED {notice of Commencement Is required.
if value of KVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
DESiGNERANG1NEE:R- , _,. Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE THE HOLDER: _ Not Applicable
Name:
Address:
may-
Zip: 'Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address•
City: State:
Zip: Phone:
BONDING COMPANY: ,,,Not Applicable
Name.
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work; and Installation as Indicated.
I certify that ncr work or installation has eommencied prior to the issuance of a permit.
St. Lucie County makes no representation that Is granting a rparmit will aut orize the permit holder to build the subject ructure
which Is In conflict with an yi pplita�e home Qwners As5acl2 tion rules, by aws or and coverlants that may grict or prohibit such
structure. Please consult w your Horne Owners Association and review your deed for any restrictions whit may apply.
In consideration of the granting of this i equested permd, I do hereby agree that I will, In all respects, perform the work
In accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a fall concurrency review: room additions,
accessory structures, swimming pools, fences, wails, signs, screen rooms and accessory uses to another non-residential use
WARNING T4 OWNER: Your failure to Record a Notice of
irnprcr�ts operty. A Notice of Cornmenci:
befo the s inspect o . If you intend to obtain finan
Signatule of pw fpffLessee/Contractoras
STATE O�R
COUNTY OF.
The fIng Instrument was acknowledged before me
or a
this „ , day of 0 r ..hZaj,::� = 2612 by
YMot Lt CiAS Iri
Name of personking statement
Personally Known OR Produced identification
Type of Identification
ilt In your paying twice for
and posted an the Jobsite
pr an attorney before
Holder
COUNTY OF
The forgoing Instrument was acknowledgecll�efore me
this day of; DI L ' IB ^ by
Name 6f pe making statement
Personally Known OR Produced Identification
Type of Identification
Praduc�tl
J]
(5ignattir�of Note d MIRE' � (Signature of Notary PuhEic tide--
U 4 F. lE K1RB
:o`"` Notary Public -State of Flo ids public State of
Commission No. =r = CamrAU- & # GG 925370 Commission No. _ � -� ;scion # GG
�? �c my Commission Expires ` _ -
"'� October 23. 2023 My Commission FY
„ « October 23, 20:
REVIEWS FRONT ZONING SUPERVISOR PLANS I�I VEGETATION I SEA TUlk- LE IWMNGROVE
COUNTER REVIEW REVIElAi 1. REVIEW i REVIEW ! R>:5/tEW REVIEW
DATE
DATE
COMPLETED
Rev. 8/2/17
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