HomeMy WebLinkAboutBuilding Permit Application r . .
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a!f At}PLfC11 ABtE INFO C!MUST BE COMP[ETfl Ft7R APPCICATiON TO BE ACGEP3ED ,; . as, (r
Date 12 28 202Q Fettnit Number
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Buidiag Permit Appt�c tan :
Ptrtnnmg-undpe*,fOpment5ervr�s �� rn��'�!n� �� �c,"=r'"?
1. 0 te l'l t
8ulldtng pnii d CadeRegulaEion Djv1$1dn C;anitil t CI3I Xx �:R_@�lttl����.�E` u(�' - �'. I � ;
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� 3p0 ul 9gyq Aitgntre,For Are":'Ft 84882
.,`Phone �(?'T2�421553.Fat� `�772462`1578 �111. --
PERNtiTA_,K;AT{C7N FC7R`�E RIGAT � I
_.
Address �3408:DALE PLACE,
Ptoperty,Tax{t7#>. LLZ `, t, .. 4 r l
Lot.Na.
;Site . I I A me , Block No;
Project Name•
CQNh EPTING�[RAIGA'T'It3N TC3 POTf1E E WATER�YSTEIt� PIpE LCC E i UN 12".BE0OW'GRAGE.
New Elect rtcal Meter
,5econi°Electrical Meter '
,.
9.
Additional work to be performed" under this peFmit check ail that apply;;
Mecharuta{ Gas Tank Gas Pi.pmg Shutters Winda4vs/iJoors Pond III-
E{ectric f?Iumbmg Spr►-I'" s Gerserator Roof °•:Pttch::
Tcstal Sq ft of ConsUucttori $q Ft.efi First'!loor
._,
Cost of Construction $ Utilities Sewer,.` Septic Building Height
Name GARR iNKESTlt1NT.PRQPERTIES� RUS tEE Name`J�FiN. ,4NLEY
address :1331 CORDO !A Flat 306 - -
Cr�mpany 24 PLUMBiNG LLC
City FOR7lAllDERt]A(.E ,:.,- 5tat'e Address,5035 N-HIATUS Rf ,
dip Code; 33 .19, Fax; ;:SUNRISE
1?hone N,o g5�1 ?id 784 ;
. City. State i=L
#335i
dip Code C"
, E-MaiI-ANDREWSGAPI,,TALCUFtPCQCC3MCASf.hdET .`
„Phone Np 554% 25t73t}4
Filf in feerslmofe Title Holder on next�iage(it different E-MaifJ0HN 24-7F'C 11MBi1aIG GQM
from the fawner fisted atiove) State Of Coiantyi license G C14267 I
.
[f,va{aeof tdnstruttlon is 25r3orar more,a RECORDED Notice of pbr,,riencenient is required
tf va{lie of PIAVC Es S?.Sf10 or-pore,a RE L'L', Riot{te of Comrttencerrierit is,'. .. ed
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DESIGNERJ)rNGINEER Not.Applicable Mt?ttTGAGE CQ{ttiFANY: Not�Applicable
Marne:
Name;
Addp'ss Ad ss:
Clty State: City:' State:
gyp: -Phone zip: Phone
FEE SIMPLE TITLE HOLDER: Not Ap0,iicable BONDING C0MPANY Not Appifcalle
Name;' Name: .
Address.:
Addtess:;
City
. , City.-
Zip:. Ph Zi Phone:
one: p:OWNER/CONTRACTOR AFFiDVIT:App#tcetiori:is hereby made to;obtain a pt rmi to do the work and installation"as inafeated. `
I'ceriify ha'no;workor'installation has commenced-prior to the issuance of a,permit,
Which,is`n con€lt t with anyapplicableiroioe that'wners�Ar sstoc permit
nt ruesauthorize
6y ai wso the
'coo it holder to build the subject p structure
` � r and revenants-ihaf may restrict or prohibit such
structure.Pleastticonsuit. rttFr,your Horne Owners=Association aErd renew your deed for;any restrictions which may apply,
In consi%leration of'the grantlri�bf this,requested permit,I do her4ny agree that t Willi in all respects,perform'tbe vrark
in accortinte with the approved plans,the Florida Building Codes and St_Lucie County Amendments,
The follow ing b9ilding permit apphcations are gxempt from undergoing a full concurrency review:room additions
accessorystructures,swririx►ning pools,€anus,walls,signs,screen rooms and accessory use to another non residentia4 use
WARNING TO OWNER;YrsuK failure to Record,a Notice of Commencement may result in paying twice for
improvements to your property.A Noticeaof Commencement must be recorded in the public records of St.:_
Lucie County and posted can the jobsite before t ie€rrst lnspee inten`c fio obtainmfinancing,consult
with lender or e b ee commencin wgrk.or re atln• v. ce of " mmencernent;
V ,
.sighit ree,of0" rl�Les" 1 actoras atu � rtcrr/License'Nolder
Agesst idr Owner° sign,
STAT, OFF RIDA ZI FLORIDA
COu. �3:� r 1. c t TY-OV i. lg'ZNQ CA
Sworn iv for affitribed}an subscribed before me of : sworn to(or affirmed)and subscribed before me of
PhysicalY Presence or� Online Notarization �P'ys aI Presence or Online,Notarizklon
this da o€: 4 '( f't *-.2020 b t}iis. �Y of 2020 by
JAYSONONESCHUK i JO iN HANLEY,
Narne of pe'rsonmaking,stat4ment. Name of person making-statement..
Personally know,, Olt Pr'pduced ldentification Personally Known OR Produced ldentification
Type o€identr6cat<ar[ Type of Identification
Produceii Produced' §a= :' l_
(Sig ature'of No
_,.PATRIIAA>�R CFiACON �g PATR#GiA IWN CtiAGOX�
Cammissron No.; Y COMRt� tC}hl Commission N Oh9t I$SI OG 30474
st 1 3oi474 _' EXPIRES Avgus(l,2tl23
t.•..,.,r�'� .EXPii ES:Augtr'S`t..i,.3423 ;r.:._•3�
REVIEWS F. PL�IiVS tt �"r�� S ,n TLE iti+lAi�£GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE.
RECEIVED
DATE`
COMPLETED