HomeMy WebLinkAboutBrown Kim AppII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Datey Permit Number:
i„
Planning and Development Services
Building and Code Regulation Division
2300,=-Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE: P
Building Permit Application
Commercial Residential
Address:
Prop4.ty Tax ID #: a 4 - QNT
Site P.jan Name: L IL
Lot No.
Block No.
Additional work to be performed under this permit -check all that apply:
.1 Mechanical _ Gas Tank Gas Piping Shutters Y.
Windows/Doors
Electric Plumbing _Sprinklers _ Generator Roof Pitch
Total'sq. Ft of C:nnsrru^*ion: _ . _ Sq. Ft. of First Floor:
Costof Construction: $ / rJ (._ Utilities: _ Sewer _ Septic Building Height:
Na
oG6r4 State:
Zia Code: _`�-'f S Fax:
Phone No..g - 14aSL-
E-I`�6ii.
iFill� in fee sirnple Title Holder on next page (if different
frgm the Owner listed above)
Name:_1utff
Company: SC.
Address: Ito 13 k- b0 Dom'
City:'?f(�n..1iXbliu►�a State:_
Zip Cade: 3a 3 Fax: Sat-?'i�
Phone No "7"7 A- 33`1- " f''70
E-Mailg '
State or County License QR75.0
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If vaiue of HVAC is. �7,500 or more, a RECORDED Notice of Commencement is required.
DESK GNER/ENGINEER: _ Not Applicable
Name,;
MORTGAGE COMPANY: Not Applicable
Name -
Add "ress:
Address:
City: State: --
City `' State:
Zip: -moPhone ----
—T
Zip: _._.� Phone: --
—
FEF SIMPLr` TITLE: HOLDER- Not Applicable
Name:
BONDING COMPANY; Not Applicakfle
Name:
Actress:
Address:
City:. _
City:
Zip-!
). Phone:
Zip: Phone: —
DWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation asp indicated.
I certify'ihat no work or installation has commenced prior to the issuance of a permit.
;tCOILIW rriakc s no representation that is granting a permit will auihos•ize the permit holder to build the subject structure
vhich i n conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
itruct. re. Pinas '� consult with your Home Owners Association and review your deed for any restrictions which may apply,
n conWeration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
n accoj'dance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
-he fol)v;wing building permit applications are exempt from undergoing a full concurrency review: room additions,
Icc�ss jr, stru171:.1res, sWinming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
`WAI25 WC TO OWNER. YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
I'llWKE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POsilTEII ON TIIE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, ;CONSULT
W14.'q H VOCR LENDER OR AN ATTORNEY BEFORE RECORD&C YOUR NOTICE OF COMMENCEMENT."
c
Signature of Owner) Lessee/Contractor as Agent for Owner
COUNTY C ` -- - - --._ -- ._ _- —_- - ----
The i6r�;oin8 instrw rlen t was acknowieagc-d :;-fore me
this day of _ 20 by
Name:of person making statement
Percp90r y Knowr ._• ..---- OR Produced Identification
i ype'o'fl iaenvficatior, I
Prodd.cod .
signature of LontractorfLlcense Holder
E STATL OF FLORID
COUNTY OF W RAZ"
1'hul instr u ent was acknowledged before me,
o_�
o
7ng
this day of ` 20! by
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IL �, E
a
Name of person making statement.
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Personally Known OR Produced identification."
Type or identification
Pro
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ured
1
re or Notary F UblIC- Slate of Florida i
of Wary Public-
Corrfrrtission No. -• (Seal) Commission No.����.��ry
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