HomeMy WebLinkAboutBuilding Permit Application - VanBlois �osn 310 �
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All APPLICABLE INFO MUSK BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
C:
V Q
BU '11d1' n .7 Permit Appisication
Planning and Development Services
Building and Code Regulation Division Commercial Resi dentia l
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 4624553 Fax: (772) 462-1578
PERMF APPLICATION F OR :
P W
-PROPOSED IMPROVEMENT -LOCATION.
Address :
Property Tax I D # -0 � 5D2 ��Dl • 0�9Q • DDO . S Lot No.
Site Plan Name: Block No.,
Pro}ect Name ., V U
DETAILED DESCRIPTION OF WORK:
%WOW
- -
_ fc�ev�4e . �rc,avc.
a aac - t Cot e �
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION : -�
Additional work to be performed under this permit — check all that apply;
_Mechanical Gas Tank _ Gas Piping _ Shutters _ Window oors _ Pond
_ Electric _ P l u m bin g _ Sprinklers , Generator oo' Roof _� P itch
Total Sq . Ft of Constructi n : ��J Sq. Ft. of First Floor :
Cost ,
n: $of Constructio d � tl ��Lac Utilities; _ Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR :
Name Name : 1'Z. 11111
Address ,•r�(3 /�tiZGS V(1 �-- Company:� �N,�.000S'�li
city* State : 1=1 Address : [!ffJ5R ;5tgS N ( e(i'
Zip Code : �'q5777 Fax : City: LuC,Ge. State :
Phone No. Zip Code : Fax:
E-Mail : Phone No I (P 21.mD 1B .
i fill in fee simple Title Holder on neat page ( if different E-Ma*1 C) —�' ' � 1C . C.p rys-ftN �
� from the Owner listed above) State or County license
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of H1aFfC is $7.,500 or rrroreg a RECORDED Notice of Commencement is required.
SUPPLEMIMWMENTAL CONSTRUCTION LIEN LAW INFORMATION .
DESIGNER/ENIGI NEER . Not Applicable MORTGAGE COMPANYO Not A
plicable.
Narne .
pt- Name:
I Add ress :
Add
ci t Y : State : City: State :
Zi p: _ _ _ PhoneZIPS Phone :
SEE SIMPLE TITLE HOLDER: N ab A p PH c a b 1 e- BONDING COMPANY. Not Applicable
Name,
Namet
Addressf Addresse
citY4
City :
ZI P: Phone: Z ;
ip , Phone .
61
OWNERJ CONTRACTOR AFFO%flTae Applie�tion is hereby made to obtahn, a permit to do the work and installation as indicated' .
I certify that no work or installation has commenced prior to the issuance of a permiL
� St, LuIc.Je Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
����i�:h �s in cQn�ict with any applicable Home owners Association ales, bylaws �r �flc� �.���nan�� ���� r���y restrict c�r� prohi-bit such
s��������. Please �r�r�su�� ��r��� ���� #� ar�e C� rne�s A��Qci���rn a��i re���� Vour deed f�� any r�s'�r���i �� � �vh �c may apply,
In consyderation of the granting of this requested permit, I do hereby cfgree that I will, in all respects perform the workaccordancei� ���� � ��� with :fie approved plans, the Florida Building Codes and St,, Lucie bounty Amendments,
The f-ollowing building permit. app'Nrcations are exempt fronn undergoing a dull co r y review : room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessary uses to another non-residential :ise
WARNING TO OWNER : Your fallure to Raacord.,,. El Notice of Commencement may result in paying twice for
imp,';'ovements to your propertV,, A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection . If you intend to obtain financing, -consult
with lender or an attorney before commencing work or record.,ing your Notice of Commencement,
voo" -- A-
gnature of ovvner/ Lessee��c�ntractor as Agent for C�vvr�er Sign e of Ca &i- ctorf cer�seR o7cTe-r
STATE OF FLORIDA� ��� � , STATE OF FLORIDACOUNTY i COUNTY OF
t� LL
Sworn �c�� ��firr�t�t�} and subscribed before me of Sw�� �� affirmed) a s� screed before me of
PhNisical Pros nce o !� Online Notarization 1 `1F1reSVq%0,'e or Online Notarization
this � day of � 2(�24 �� ��i� Z d��r �� 2021 by
I r e, 170, 1
Name -of person making statement. ------ AameOTperson making state - nt,
Personall no OR Produced Identification Personally Known OR Produced Identification
Type of ! entific w.i Type of ification
P rod uc d � Prod ced
i
(Signa�ure of N6(ary-pubficu.
S of Florida } (Signature f 4otar bi - to K&� State of Ftorift
commi ela Jones eal) Co mis�lon No., _ , omr� EGG 985470
NOSY Pub�k
Srsi� � � Expires (����t#24
MY Commift
REVI FF*JWTo6j1sf o SUPERVISOR PLANS VEG ETA ION SEA TURTLE MANGROVE
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