HomeMy WebLinkAboutGeib Permit APPAfl APPLICABLE INFO MUST .13F CO KETED FC1R APPLICAT[Ofy To gE ACCEPTED
Date:
Permit lumber-,
EEC 2- Is
—
� � a
u i ld n Permit Application
Planning and Oe�relopmer, r ,�enrio�S
Building and Code Regtjjo�n D+vi5'rari Commercial
23 1arg"'k2 Avenue, Fort Pierce FL 349s2 ��� I � � Il � E� �
Phone; (772) 462-1553 Fax : (772) 462-1578
PERMIT APPLICATION FOR-
SIte Plan Name-,
Prof-ect Name- r• L & er f }
D ETA I LED DESCRI PTI ON OF 1 R: -
Ez
New Electra-ca I Mete r _ Sewn d E le ctrica I mete{
FCONSTRUCTION I NFORMATION,
Lot N o_
61 ock N o-
Addit[onal work to he performed under thE.5 permit, check ail that apply:
—Me chantcaI _ Gas Tank Ga5 Piping Sht;twrs
_ V4find0Vrsf Doan Pond
— E f-ectri r- — Plumbing _ Sprinklers Generator _
= Roof Pitch
Total Sq- Ft of Construction,:
5Qr Ft. of J=i rst F I ter:
Cost of Construion: r, -1 �ftii�tis:
��'•� —Sewer _ 5.etic
OWNEFL LESSEE- —
Name i ef� -
AddrP-5.5:le
c,
cltw •, State:
Zip Code- E
afar rye-,
Building W-Ight-
Company: � { �.r} � ;� ��4 -
Address: a-,
fit}+
Phone No, I
Zip Code: Fax:
E' Mil: Rhone No
Fill in fee sir. fe Trtj
Sta f e;
JO on next Rage I if different E;- I'V a i I11
r#
from the Owner I f steel ahmDvej 11
�� � }-•
r CoUnty Li ens
If value ofronStTUaton is 250''0 or mo'rL-, a RCORDDED Nettie Of mmencement f:5 requinad.
K uaFue of HAVC LS S7.,SQQ ar more, a RECORDED Notice of C"HwMement 6 required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW[
�E�SIGNEk/-WdINEER Not AppIJJcabie
Name:
Address: -
Ci ty ; State
Zip- _ „ Phone
FE-E SAMPLE TITLE HOLDER' Not Apca lee
Name.,
Address:
Zap: Phone:
MORI-GAGE COMPANY:
i�at Apphicable
Address-,
Cif :
-state:
110N 1 N G 4:0MPANY.-
Applicable
Name-,
_,Lof
Address:
rty
Zip- Phone:
OWN ER/ CONTRALTO R AEFIEWIT: Appi1cation is hereby made W obtain a permit to do the +nark a nd Instal I ati on as Ind icated,
c@rt-Ify that no work or instaIlation has commenced prier to the issuance of a permit_
St_ Lu c ie C-OuDV makes no represe ntation that is granons a Perm it wi I I authorize th � �rn-Eit h order to b u i Id the su biect stru ctu m
which as in conflict v+rith any appli�bte Dome miners As cGation rules, bylaws or ar��cov�r�ants that may r
structure. Pilease Vor 5UIt With +Qur -Hoene Owners kSSOCiation and re3riew your deed for any ants �' at y Fest ich 8 pr-Ioohibit such
in consideration of the granting of th3� requested permit, I do hereby agree that I will, irk arl re�Pe�ts� perform the work �
in accordance with the approved plans, the Florida BuitdIng. es and St. Luse Wr�t�spectAmendments.
The following building permit applications are exempt from undergoing a fuII concurrency review: room addlt;ons,
atcessory structures, Swimming pooh fence% walls, signs, screen roorns and accessory uses to another non-residentiai use
WARN I NG TO OWN E R: Yo u r fa iI u re to Record -a Notice of Commencment nuy for
ImPrOvement tO yoUr prDper-ky. A NoticeOf COmmenuement rustrecorded
� o ded isult in n paying
twice recard5 of St_
Lucie CoUn end Posted un the jobsite before the first inspection. I You intend t tain financing, consult
with erg r or an at efore comrnencin work ar recordin Our Nn-tic rrrrrtencerr7 ent.
nature of owner
LQSSeelContractor as Age:,jt for Owner
STATE OF FLDRIQq
COUNTY OF
Sworn ti) (or affirmed) arrd.subscribed fief ore me of
--L'PhYsical Presence o r _ On I i n-e NOta rizatio n
thi _ day of 2020 by
Name of person mal'ring statement,
Persona I ter known i O R P rod u ce d Ede ntrfication _.
Type of Identifcetion
Produced
i n ure of Nutary PubIic-- State of Florida
Commission No, (seao
. - .. �n R„
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
PLE F ED
an
Sij naturER of Contractor
STATE OF FLORIDA
COUNTY OF
nse Holder
Ymto (ar afErmed ) n nd subscribed before me of
lhysical Pr eseoce or Online Notarization
#h is _ day of 2OZO by
i
Namo of Iefsan Making statement -
Personally Known ` OR Produced Identi ficatl on
Type of Identification
Produced
{5Tgnatef P4otary
ic- State of Florida )
Cum rni nsi on Nu (SeONAL.FRANCO
jW101410t PLANS VEGETAMN SEifftT
E'er REVIEW REVIEW REVIEW
7!E UUJ?kNDL'I'y�b JCH
MAN -GROVE
REVIEW