HomeMy WebLinkAboutaqua ra pernit appAll APPUCABLE INFER M UST 3E COAJRLETED FOR APPUCATION TO BE ACCEPTED
Date:
PerrI Number;
9MCt
if 4
Building Permit Application
Planning and Deveiopment SLbrvireg
BLedding Odd Code Regalotion Div+slOr]Commerdal ce.
Residential f
2-300 WY91I . wen ye, Fort Pi4_rce FL _q4
Mon e - (772) 462- t-553 Fax: (T72) 46 2-157.8
6PERMITAPPLICATION FOR
PROPOSED
6Efi LOCATION-
Address-
a r
Propertv Tax I1)#: 'i
5J' e Nan Name.
Project Narne:
r
DETAILED DESCRIPTION OFWORK:
New Electrical Meter _ Secon d E I ectrica I Meter
CONSTRUCTION INFORMATION:
Addiftnal work to be performed under tllaS WnI - cheek all that apply:
Lot No
Block No.
„mechanical _ Gas Tank � Gas Piping _ Shutters _Vvfrrdows/D-Dars Pend
E I ectri c _ Plumbing i Sprinklers nklers — Gen erator Roo � _
- Pitch
Total 6q. Ft of Construction: SQ. Et. of First Floor,
Cast of Cc n rucbon : S qW Util iti esa _ _Sewer Septic Bu i l i nHeight:
OWNER/LESSEE:
Addrt.ss; ,
CIty: ___r Ar. state: _fit
Zip Code: Fax:
Phone No
:TCOCNTRACTOR-.
Name -,--
Company., r
Address: A b
{ VA
City: f_21 state, F/-
Zi p Cade: �'vl F€: -
E-MaH, Phone No
Fill in fee simple Title Haider on next page ( if different E-Mail
from the Owner listed a bowed
If value of construction is 2.500 of More� a RE'C RI)ED Notice of Cornmen�ement is neguirn�i.
I f value of HAVC iS $7, 500 Or more, a-RECORDE D Notice of Corn mence ment I req ui red.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERIENC31NEEl :
riot Appil icablo
Name.
Address: - -�
City: State ;
ZI-P: Phone
FEE S I M PLE TITLE HOLDEN: Not Applicable
Borne;
Address'- —
Citv,. .
Zip: Phone: -
MORTGAGE CUMPAI f; ..�
Not Applicable
Name.
Address:
CiIy= State:
Zip, Phone,
BONDING COMPANY:
Name:
Address -
City. .
zip: ph-OT1e:—._.
t Applicable
OWN E R/ CONTRALTO R AF FIDV IT: Ap pl i cati an is h e reby made to obtain a permit to de the work a nd i nstallab on as ind icated_
I certify that no work or, i nsta6latio n has rom m e n ccd pri or to the iswance c f a permit.
St, Lucie County makes no representation that is granting a permit wilt authorize the permit holder to build the subje-ct structure
which 4 in contlictwIthanyapplicabte Home OwnersAssociation rules, bylaw-s or and covenantsthatmay resWct or prohibit such
structu re. Please uonsult watt, you r H ome Owners Asseci ation a n d review yo ur deed for a ny reArickions Wh ieh may a pply.
I n consideration of th a gra nti ng of this requested perm k I do h er eby agree that I will, in all respects, perform the work
1 n accordance Wth th a epp roared ghtnS, the Florida Sui Idi ng Cod es a nd St, Lucie Lou ntV Amendments.
The following build iDg permit apialF ations are exempt from undergdn a full concurrency review. room additions,
accessory structu res, swim rn ing pa&s, fences, vwa I I sr signs, screen orris and a=ssory uses to a n other non-residenti:� I u5c
ARNI NG TO OWN E R: Ye u r #ail u re to Hecard -a blotioe of Commencement may resuk in paying twice for
improvernants to your property. A Notice of Commencement mutt b recorded in the Public records of St,
Lijcto County d posted on the jobsito before the fiat Inspection_ if ou intend to obtain financing, ccnsuIt
with lender a n —attorney-attorn-ey be a cornmencing works or recording u r Notice of � ncement .
el
5igna sire of Owners Lessee/Contactor a-s Agent for Owner
STATE OF FLORIDA
CDU W Y O 4( V,ram
Sworn to (or affirmedi) and subscribed before me of
physical Presence or O n I ine Notarization
this I� day of 6 - 202A by
N ame of pe rso n ma king sWtem ent,
Personally Known O R P rod u red Ide ratification
Type of ide ntificetio n
Produced
,_
(Sigryure of No
public- State of Florida )
Comrriiron fVo. �
iT _0I
Sig ture of Contractor/License Holder
STATE OF FLORIDA
CO U NTY OF
-Swtkrn to (or affirmed) and subscribed before me of
'Physical Presence or On line Notarization
th is T day of , 2-02-1 ICY
1
Name of person making statem ent.
Personally Known OR Produced Identific4on
Type of Identification
produced _
:L--
Si natu f Notary Pudic- State of Florida )
Corn missEon N ov _ �• �.y � �� ��g�7�
TV
RLVCEWS FRONT #� N? I SUPERVISOR PLANS VEGETATION kA YURRE MANGROVE
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RECEIVED
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