HomeMy WebLinkAboutjaschinski permit appAll APPL CA8 LE INFO MUST 8 E COMPLETED FOR APPLICATION TO BE ACCEPTE13
Date
Permit Number:
Q v a
u ildi � Permit Application
P'ar�r�rrag and Oe vefaPme�7 t 5e�rces � I'1
80d ng and Cod8 fteggiorron Djv+fsr`on Cornmerda I E
230D Vorgin a Avenue, fort Pierce FL 34 2 ResI d e nU a l
Phonc: (772} 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address � � .
1
Property Tai( ID #; . I ) S '_1�41- /wllr
Site Plan Name.
PrOject Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second F I ectrical Deter
CDNSTREJC7f0N fNFpRMA710N:
Additional work to bp- performed under this permit —check all that app[y;
` iecha nicaf — .Cas Tank Gas PipFrrg _ Shutters
Electric — Plumbing; _ SprFnkiera _ Generatoj,
Total Sq- Ft of Construction;
Cost of Construction: ti _
OWNER/LESSEE:
Name
Sq. Ft. of First Floor-,
Lot No- (
Block No_
Windows/Doers Po rhd
Roof P itch
Uti is ties: —Sewer _Septic Bra lid inn HeIg ht ;
CONTRACTOR:
P Name:
Address;
Cit,,r;
State Add
Corn pany: ;
' �
zip Code: .- f. i
_ � ? city:
r Phone rqo, s State;
yi p Code: Fax: r f. E-f lail; Phone No S�X_
Fil I in fe a 5Fmpl e Titl e H 01 der o n n ext pa ge if d iffererrt E-Mai 1 .
fr0.rrM the Owner listed above) i
�t�&e�y-r county License C
lfvalue otconstruction fs z590 c r rnore, .a RE CDR DEED NOtice Of CormmencemL-rrt iS req uired _
Jf val u e of HAVC i!s $ 7,500 or more, a DECOR -DE D NcticGl Of Co rri menceme-nt Is req u ired,
UIV Lit
D-ESINEFhIiNER; Not ADpficable
f INFOR ATUN:
N a rrl e;� -
Ad d
City:
Stat��
P : Phone -
FEE SIMPLE TITLE HOLDER: Not Applicable
-
Name:
Addre$s;
City:
L Z'
_ Phone:
F%tib fKk
MORTGAGE COMPANY
Nt4pplicable
Address:
City:
tote:
Zip: Phone -
Not April ica plc -
Name:
A dd rem'
C ity-
Zip: Phone:
BLINDING COMPANY. -
Eli -Vim I KRLTUR AFF1DVIT: Application i5 hereby made to Obtaiq a Permit t* do the work and installation a
I certify that no work of instalaation has c�ornmenced prig to the fssuanr,.e of a perrnk, Irkdi aced.
5t_ Wcie Cou nty n-,akes no represention that is granting
wh i eh I s i n ca nfi ct Frith 3DV a Pplicable Horne Owners hoc perm
t nI r eIs,abyl ws or and coven an s that h� ril d the subject strr r�� r�
.structure_ Pie a cOn5uit With ycRir Home Owners Association and r�+f�w our deed for an rests �tio s Wh r�},tma a prohibit such
In consideration of the grantirIg o�fthis requested Permit, I do hereby agree that I will in arl respects, � work
Y
i n acr-ordan ce with the app roved plans, the Fiorida 8 ui I di r Codes and 5t, Lucie Cou my Amend m ents perform, #h� vwork
The folfowing building permit applications are exempt frorn undergoing a full concurren re+rfew. room additions,
acce-ssorV structures, Swimming pools, fences, walls, signs, screenrooms and -Ress0rV uses to another non-resMeLntral use
WAR NJNG TO OWNER: Your failure to Record a Notice of Commencement may rm It in twig for
improvements to your property. A Nctrce Of C-0rr,mencernent Must b recorded #h public recordsf
Lucien d posted on tfit_
jo sit before the fiat rns ecti n, ou intend to obtain financing, consult
with leadCouer Sri att ne fare c m mencrr� ork or reeordin our Noti Commencement
[Signat re of Owner;
Lessee/Contra or as
Agent for owner 5 nature cd Ontractor/!_r use Holder
STATE OF FLORIDA
C4UNTY O I
5 orn to (or affirm-ed) and subscribed before m.0 of
P hy.5ical Priesert or — 0 n I ire Notariaati n
th is —day of .2020 by
Na m L' afperson m aki ng statement,
Persimally Known _ OR Produced Identrf«cation
Typ e of rdentifi cati on
Produced
(5rgnat
Notary Public. State of
Comm l'Ssie n No, +' �
REVIEW
DATA
RECEWED
DATE
COMPLETED
ev.
IMda
C-4
3
FRONT ZONING
COL ITER I'REVIEW
STATE OF Fri DA
COUNTY OF �
S orn to (or affirmed) and :�ubscrfbed before me of
Ph ysi ca I Presence or — Onli no Kota rization
this _ day of 2020 by
— 14 J1 '.:�a 6,1
Name of p-er5on rna king statement,
Personally Known 0R Produced Idenbfioation
Type of id-eatFfir_at an
Produced
riature of
5UPERVISOf I PLANS
R EVI!EW REVIEW
tarp+ Pu b,l ic- State of FI on da )
��IAL. F *�
F� . Q, --
VEGETATION SATUATLE MANGROVE
REVIFW REMEW REVIEW