HomeMy WebLinkAboutBUILDING PERMITAft APPUCABU Illf MUST BE CDMFLETED FOR APPUCATrOM TO BE ACUEPTE-D
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Building Permit Application
PyanwrWq ovid Devrar Sew
SuAding an-dCone kpguhatloft rSr 7 COmmerdaI Re-sI� n Idl
21'OID tili'rgrma Aw4mt1e, FOrt Ft 3�4982
Phone: f 772� 462-1553 Fax: {772, 462-IS78
PERMIT APPLICATION FOR:
PROPOS E b I I PROVEME NT LOCATION.
Add ri-&s
jR_
Property Tax ID 4: )L Y Lot No-
Site Plain Marne: — Ply NG.
Project Time;
DETAILED DESCRIPTION OF WORK,
Y r
fr 1,11, r
Newo Elechicall Meter SeoDnd J'tect4call Meter
NSTRU0ION 1 NFORFAATION:
Additjon@il work to be performed under this permit — dieck all that a pply:
_Mechmical —Gas Tank _.Gas Piperk _ 5hutk�rs _ Wfnd+ows/Doors : Pon
learfc _ Plumbing _ Spriinklers _ Grrrcrator _ Roof Pitch
TOW Sq. Pt of Canstru than_
Cost of Construction: $ �� —:1-a c,
OWNER/LESSEE.
S�_ Ft. of First Floor:
Utilities: _ Sewer _ Septic
Adder; L� (j lC j4f
city-. _L -L- sue: i c-
Zip Code: yi` � i .L Fad ,1l
- -
Phonie No. a (- q12
E-Ma-LI:
Fil i n fee simple Title Hider on nen Page I if di-ffemnt
ft9m the CWner lard above)
CONTRACTOR.
Marna:
Bu i Iding y iei-hrx'
Address: + lgie � �L r
Zip ems; �'�� � � Fax:
Phone No '� .l:�- 5�)_
E-mail A, e 1, 21 C ! ,q •�
Store 4>T minty License � �i 7� ` I
If era We Of con!'teuction 4 2 -or more, a RECORDED Nance of Commewemew is required_
It value of HAVC is $7,500 or more, a RECORDED Natice of Commencemerrt is required_
SlyPPLEMENTiAL CONSTRUCTION UEli LAW INFOR MATION:
0E9QK1EAjEN GINEEM = _ Not Ap pRicab1-e
AAORTGAC E COMI PIANY= _ Not Applira-b4e
Nam,
Narn; -
Address:
Add r es6:
City: State.
City; -Late.
Zi P. Phone
zi p- P hori-:
FIFE SIMPLE TITLE HOLDER, _ Not Ap ptircable
BONDING COMPANY: Not Ap pl [cable
Name:
Name: _ - -
Ad d ress=
Adiiro,s:
Ci ty_
'�ityr_
Zip: P11me:
Zip; P1,ore;
OMF NTF AICTOR AFFIOVIF= Appdicatian is herebry made to oluin a permit to do the work and installation as indicated.
I certify that no work or instidlation has commenced prior to time iman+ce, of a permit
St Lurie County makes no representation that �s granting a permit will authorize the permit holder to buad tine subject structure
which is rb [n irl4d with any applrr,*W Ham-e Qwne!rs ,4% tiorr r4Ak—,., byla MS i%r and ca%*rsarrts ttrat enay re�itrJrt or pr-abibit such
Wuctur*. Plea• oonsulk with vow Horne Owners Aywciatian -imd review "ur deed for ar9V rt ions whits m.&v AP -
In oarrsidieratiian of the granting of this requested perm ity I do hereby agree that t wdk in all respects, perform the work
in aixvdanoe with tFri.- app mve(I plans, Ute Fiarlda eud$injz cores "d 5t Lucie Cooney Amencimmu,
Th-e rollowinp husIdir<p m it ;)ppl t*A1 ark` -en4bpt ftm ur?d-erguir% N (ull oonUrr-emcv vewi ; mom addwtion&
aocessorw structures, swimming pools, Fenced walls, signs, screen rooms and accessory uses to anotheT non-residentiat use
WARNING TO OVWXER- YOUF failWe to Record a N060e of Commertoerrtent may result inpaying twice for
i mprowem nts to your property. A N otice of Corn me ne.L-ment must be re-corde d i ri the p uh I is records of St-
I-Lb6e Courirty and pad on the jobsite befo re the f i rst i n:5pection. If you i Me rid to o bta in fina nc irtF, consul It
wirth lender or an attornev before cornmemFne work or record i ne vour N Mice of Cartirm! nc-e m4nt.
I ,
Signa1:gDL--df wnerf Lesse a5 Agent for owrWr' � {
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a-iQ-M-- 1-101 eq
STATE OF FLORIDA r I STATS OF FLORiDA
COUNTY OF- Lck -( L -t COUNTY OF Ll-.�x el
�to (or afPFirm e) and 5u�tribed before me uF Sworn (or adfirrn ed j and subscribed before rare flF
Physimml Presence or Online Notari�ativn � i " I PraS of 01 jiirre iqwp#n
this �$Y of � - 20M by #hid � y �! _I�' 0.�: n �� A — 2020 b3+
Name of pemort makIna utmervreft - -- - - - Name of person making statrernem.
Personally Known DR praQuced
Type of Identifsration
p4`r tore of Rotary Public- State of fIorida
Commission Flo. (NG a ise,al)
1�n PersonaDy Known 'x x OR Produord Identification
*. Prc�
'9_ {Stz#ure of N PuNic- State of Fkwid$ I
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Co"imission NM L T {seal} a
LLA
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s REVIEWS I FRONTI ZONING SR�C R PLANS 11�EETA7lf� SL.E FJ
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L COUNTER RCV� VILRLVIEVV RIEVIEW REVIEW
DATE
ODNLPLETE D
I C:�;?� 11
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