HomeMy WebLinkAboutBuilding Permit Application i
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An APPl1 'I w wo MUST BE COMPLETED FOR APPLcATION TO BE ACCEPTED
Date: I I�J���� Permit Number. 5'
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Building Permit Application
Plormfng and DevefopmentSenmxs
Ru3d#ng and Code Reguk"n&vaskn Commercial Residential
23W VhWnk Avenue,fat Pkrce FL 34M
Phone:(772)462-1553 Fax:(772)462-1S78
PERMIT APPUCATION FOR:
Address: d
Property Tax ID#: Lot No
Site Plan Name: WV" �At Block No.
Project Name: It
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters —Windows/Doors Pond
_Electric _Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq.Ft of Construction: 1300 Sq.Ft.of First Floor: 13-4yov
Cost of Construction:$ ILI 1 oil Utilities: _Sewer kSeptic Building Height:
Name Name:
Address: Company:
City: xt State: Address: it Ml
Zip Code: % Fax: City: State:,,
Phone No. z Zip Code: Fax:� y lgy f 11�
E-Mail.• Phone N
FBI In tee simple er on next page(if different E-Mail t
from the owner listed above) State oreCoun�ItVtcen�se2&pft
#value of consbuction h 2SOO or more,a RECORDED Notice of Commancemam is requh+ed.
It value of HAVC Is$7AW or more,a RECORDED Notice of is required.
60
_Not . MORTGAGE COMPANY: _Not ApplkaMe
Name: Name:
Address: Address:
State: Citr. '
Zip: Phone Zip: Phone:
FEE SIMPLE MU HOLDER: _Not Applicable WNDIN6 CON FANY: _Not Applicable
Name: Name:
Address: Address:
Phone: ZlW.' Phone:
OWNER/C Ni I RACTOR AFFWVIT:Appiicmdon Is hereby made to obtain a pemrR to do the work and insudadm as A+ ed.
i aar*dw no work or loon has commenced prior to the Issuance of a permR.
� 'act& �W such
In oomideraticn of the gmndmg of this pwmltr I do hereby sgme that i wK to aN perform the work
to accordance with the approved plw4 the Florida Burg Codes and St.tuck County Ame
The fokmft bu ft permit apokad s are exempt from mdergoing a ful ooncurretncy mvkwr:roan►addidom
accessory sbucpa 4 swkvnMg gook fence;,walbr sigrrr,,screen rooms and accessory uses to another non4esManU use
WAt 6 TO OWNED YourfOom f o Record a Notice of may result In pe ftb ioe for
improv+eniients to yotr property.A Notice of must be recorded rn the records of St.
Lucie Cmm and posted on the jute before the first inspection.If you Wend to�nmKin&coristdt
with lefm:kworanktwnevJmfm m conwmdng work or reix"ng your Notice of
Oohv
Signadme of Lessee/Oontraemr w Agentfar Owlnw Signature of Flolder
STATE OF STATE OF FLORIDA
COUNTY OF COUNTY OF_ ti R�+oFo RA
to(or aFflcn and wbsaibed before me of to(or aftfrn ed►and a hsabW before me of:---. _
Presence or Once Nat on �Presence or Ordne Na bs
t�this
bV
12�c .�
Name of person Name of person atabernent.
Person@RV Known OR Produced idend6cation 0L PermmRy Known, OR Produced W on'r._,,_
rt" �1V TVpe roduca�n - r
Produced_
�l aZ1
Of4_ zabeth Roberts Of
Commission GG 9370 6 4 .,
` $ _ Commission#GGi�
Cr=rdn sion No. Apim�(riwtlrea?2JOa 2023
..a..I pst 2'
Bonded Thru Troy Fain Insurance U0 3857919
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