HomeMy WebLinkAboutApplicationAll APPLICABLE INFO M UST BE CCMPLETED FOR APPUCATIQN TO BE ACCEPTED
Daw: L1
Permit Pdumbee;
t- cti t:� L L Building Permit Application
pffm my vneo 0rWQM7{,; s 5�rlvxes
&06ng avid Cade ReyWagew DiwFshm Co rnm erg l a I Residential
23W V7Fgwrro,4vwue, Ford Pierce � t Z
Phone: (772) 462-155� fax: (772) 467-1578
PERMIT APPLICAT10N FOR:
PROPOSED IMPROVEMENT LOCATION:
r VJ
Site Plan Marne; Block No-.
Project Name:
DETAILEU DESCRIP-TION OF WORK,
New Ele#riraf Meter Se4mnct !EI f(i )l Meter
CONSTRUCTION INFORNIATIOW
ditJ Dnal work m� be ff01 lfi1eJ under this permit— f;7eCk Ali that apply:
—FAe ranical _ CIS Tank _ Gas Piping —Shun-,(s Windows/Doors Fond
, dectrlc _ F`It mbirig — Sprinkferrs — ncratar _ iiaof P1 tuh
T=i :5q_ Ft cif -Construction: _. 5q. Ft. of First Floor:
Gov of wtrwt�on: � I UtiEittt SeweF — c 113kjlW n!g H 6p h t:
OWNER/L1= E E.
Name
aw: P. f r I „�+� State:
zip Code! -V-+ t Fay
Phone No_ - " - -700
Email:
Fill in fee simple Title FIo4kr as next gage (if drffererrt
fMFn the Owner listed above)
CONTRACTOR:
Company: AL�,A, � -.] ,-
Address: qqf3rfl€
Imo' ; ': --• Sta#e_t 4
Zip Fax;
Phone RD
E•9ail l-J4
State or County Ucens
IF value afconsLRmtiarn is 25M *r fir, a REED Notice of Cornmereenwo 4 ccwirvd.
IF yaEuc of I fKVC is $7.5W or mart, -a1 EOM ED Nvtke43f Commencement is regidre:L
SUPPLEMENTAL CONSTRUCTION (LIEN LAW 1NFORMATION:
60--dNER/EN-GINEER: _ Not AP
Narrie=
Address:
zip=.
_ Fhone
State:
FEE SIMPLE T -E HMDER: Not A-ppl iK:;a ble
Na-me: .
Add ress
City___
zip: Phone -
MORTfaAU COMPANY: Not App�i eablie
Na one=
Add ress -
City- _ -- State:
zip: Ptto n e-- -
BONDING COMPANY-. __Not A:pplica ble
Name:
Z-19!
OWNER/ CONTRACTOR AFRDVFT. Appliratiow ii� "rebw made to obtain a permit to do tht- work $nd inswilaxivn as indicated.
I certify that no work *e 1r104lation has commenced prior to the i uarme -uF a perm it-
5L Lude Coun rnakes,no representation that is granting a permit wit �ruth�perm 42 the peholder to build th,e SlUhjKj �krrKtUrC
which � Fn con idt with any applicable Homrik- Qwnrrp ,4�ftn ruie:s, bylaws or and covwnont* th0 may'restrict or prnhlbit such
Aruc ure_ Please coo suit ti►ath your H<3me Owners� Aa�abon and review your 4ez•d' or an'y restrictions which may appky-
In mnsidera tiorr -oC #bc Rranting 43# d4is requested pffmjtr J d4 hc,rchy agree d4at I xilh, in Aa resp", pr.r1wm the work
in KfAr4ancewith khe approved plans, the lfxrda BOWing Codes arad St Luwie CowgyAMeF4r'-ent!,,
The fvpvwing building permit appLicmflons are exemprt from undergoing a full eanwrrency raw: room adilitkrtsr
a c cesso ry = LKlurers, 5 w i rnming cools} fences, wad4 #iong, Sacen r400ms and aoness,ryr uses to anp r wr-reiidentiid use
WARNI NG TO OWNER: Your falure W Rwwd a Notice of Commencement may result irk paryinig twire for
i rr5p rove me nts to your grope rty_ A Notir a of mrne:rwement rn ust be ramr&d in the public records of St.
LuGae County and posMd ion the jobsite before tive first inspection_ if you intend to ohta i ri fi rSaincirg, comult
with Ie rid er o r a n attorney before comme rrcina work 9_f_record fng your NotE ce of Commenoernerit_
Signature of: r{ Lrt {C�acwr'asA t forown{D atumaftorrwa€for{JT r,W Holder
r_
STATE OF Ro RIDA STATE OF FLORIDA
COUNTY OF COtj NTY OF C, took a_,: �-
Sworn to (vr affirmedl and su 6b-ed b0ore me of
rpI Fft" or Online -NciL fi;;oti)Tl
this day of /+ Z024 by
Nara r QI peryun makiTkg statement.
Pvr-,rmulFV Ka-*u-.v'1 ¢ IdQntificabvn
Typekof identification
r�
Rrodud •Y � �ti. --
• M1} �Li*fir .q,
Swof:iI-or affirmed) and subscribed befprQ znu -of
Physical grew o _ Online Natariiation
this l l21y 01 _ 2CO by
w L,'-Je-
Name of person making ="e
Fcrx nally Known opt
Typ4 of ui ntsfi �aWm
kNgr FUjP, Or R101[bfw riJDIIC- ltatE 7O 7& llfp re Of M� • f
�: , Pmbrpo S}-L-a� to or Rorida
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REVIEWS FFCOPI f ZONING Sly PEft�, WFR FLAN 5 VEGETATION SEA Ti U FkTLF-FMANG E
.COUN ER (EVrLW REVFEW RF01EW REVIEW REVIEW �EVIE6V
DATE --
RECEIVED