HomeMy WebLinkAboutbuilding permitAll APP=_t
MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED
Vie' o Permrt N.Umber.-
Building Permit Application
Rdnnmy uad Dcvdopmrnt Services
0.0&ng and -Code RegvJa2iorr a�-;�'o, Commercial Re�idenbal
.2300 lfrrgYnwAvmi. e, Fart Pierce ;-t 3MZ
Phone; (?7Z) -1553 Fax: (T72) 462-1578
PERMIT APPLICATI0N FOR:
i
P ROPOSE D ffVlPROVEM E F L(YATION •--
Address_
Propertyr Tax ID R-.j - vat - o Lot NO.4
Saxe Plan Name: Block No.
Proms# Name:
KTAILED DESCRIPTION OFWORK:
N 8w fleitricul Mcter Second E I�rtaacai Wtefr
CONSTRUCTION I N F DRMATI Oft:
Additional: work to bc, performed under ThEs permft—check all that apply_
TE►+EesEaruc l _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pr;n d
Ptumbing _ Sprfnklevs Generator Roo; Pitch
Total Sq. Ft of CanrAructfon_
Cost of Consfruc'tlon_
OW N ERILESSE E:
Sq. Ft- of First Flgvr_
utiltk`5" _ Sewer _ Septic Building Height:
dress: ..Al').. 1 'r; '
city: svft:
Zip C&iL- FaM_
Phone No.b
F-Mail_ .-
Fill in fee Simple Title HOW er on next page (it different
from the Owner listed above)
CONTRACTOR:
Company,
Address: f r� r C—
'-iLx-.
ZipCode: Fax_
or Couray License
If value of corms ckk;ln is 2500 or more, a RECORDED Notice of [crmnwnbe� k rewipVd.
It value of HAVC is �7,5w rsr rt%brz!r ;m REODRDEa Notice of Eomnvarmeummit is required.
N ot Ap l i s b le MORTGAGE ?ANY -
Name:
uty, State•
Zip: -- PEtone
FEE SIMPLE TITLE HOLDER: Not ArpplicaWe
Name;
Address:
Zip, Phone:
SU PPLE M E NTA L CONSTR UCTIOM Ll E N LAW ] WEAR TION-
I .SIGN ERIENGJ N EEA r
Not Ap pl i cable
Name. -
Address:
City_ _ State: _
zip: Exhon.E=
EON D I NG COMPANY: _N Qt ,gyp pl f cable
Name:
Address- —
City:_ _ --
Zi p,—
�I
OWFAW CONTRACTOR AM 13VIT: Ap;pIication is herk-4 made to abta in a permit to do the work and 111*tu]Iation as indicattad.
I uerffY th.A[ nio vmrk or installation ha* cm menmd prior to the iysuartce of a permit
St LLKie n#)r makes no reprfseritotim that is gra�ng a permit wif ra I authoe the -rrnik helder to buad the suhiect Structure
wh ioh eF rn Conflict with sny+a pp i�Fjfe Wme owner$ , -zc cwtlon rules, byelaw.% c r,,rad covenants that may restrict or prohibit such
struaure_ Please ron_Mt'onth your Home Owrrem Association a nd regrew V*ur teed for any Fearktlions whk- t may a pptY-
In ronsider9ion of the gra n.ing 4 th r, rcq uested permits 9 dv hcr4eby agree that I will, in all respecM perform the work
in acoordartce with ttie appro„od plans, the Florjda BuiNing Codes and St. w(■ a County AmendmenM
The foRowing buiWirg permit appl nations an- ew-mpt from u ndergaing d full conctierrency revFew! eogm additions
accessory %tructu re-s, swimming pool, lonves, wal Is. signs, -Sc een rooms and accewni�v w.,cs to another norrreWen#iA ume
WARNING TO OWMER: YOuF failure to REeofd a II40tice of Cornrnertckt t may result in paying tvfke for
i rn prOvements to you r p rc, party. A N otice of Corn rn encemerrt must be recorded i n tJte pull is records of St_
Lucf a Cori My a nd po.5ted on the jabmte befo re the f i rst i nspection. If YOU i rtt� nd to obtaf n frna racing, consu It
with ie nder or an attorr,c-y #efore can'srn&ici ng work or mcard is Qu r N otice of Comrne rice relent.
n. Chnrne0 tessE, btor as AgenffGr Qnm�r
STATE IMF FLI *
COUNTY OF
Swum (or of iiFme(J) v nd subsuibed before m c of
;.Mml! Presence or One N-o#arizst6n
fhl day of ' 20n by
�• i
Name of Verson malting $#;)kcment
Pt-i-54 malty Known, , 0R Produces GdmDfiU0j0n
TvPe of Identilkadon __Ah
--I IL
—
oF Notary, Public- mitt of Roriida }
t
n NU_ Fi (5+eal]
REVIEWS FRONT ZONING S
COUNTEit REVIEW R 95
GATE
RECEJVE G .
n! 1Licens IQer
STATE OF RORIDA
COUNTY OF St
5wmrn tq{or ff firma-d I anO subscribed befork- roe pt
P k+ sir rl Presence or QniirK- Notarization
this f aY of f_ , _ t .� . 2021) by y
Name of person ro;)kiFw, statement
Personally Known _L-'' 'DR Produced Identification
e TVP.of MenriFicadon -
Pirtr$u d .'.l-"".
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L $ au . .
�f tlotaru �ublit- S�Ge Kd Fbtrrid� M � �
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PLANS IVE131ETATION ISEATURTLE
'EVIEVY REVIEW RFV1tW
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