HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONij
AII.APPUCABLE IN MU57'B COMPLETED i OR AOLlCAT[ONIM E,AGC,W.Ab
Date:. $ I'... _ Pet0fNumber IYJ�
7 a
>?� a -e --::K; Building Permit iplicaEt
Planning and-DeuetaprriertE Services - - "
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Burtdrngand;CodeRegulat�onaivisio» Comrnercla'� RE51d811L1d:%.
2300111rginrd.Aventie" _F 4' Prerce FL 3:49V
Phone (772):46z=1553 Fam.Oli): I-1578
Address
Site Plan' Name . J Jln]►1 In W1.. 1\115
V.
N.ewIlectrical'.Meter .SecondElectricat.Meter,
Lai No
Block No_._
ff"ro F/A , . � MW—w-n
Add1tional.vuork to be performed under this`permt cheek ati that appiy
_Mechanical _Gas, Tank' _^Gas Piping Shutters WindawVbbas_ Pond.
Electric _ R(umbing SDnnklers Generator Rool Pitch
--,
Total Sq; Ft of Construction: t Sq Ffof First°Fiagr:,
tt
C6�t df Construction:`
$ Utii ties* Sewer Septic: Building Height e
0�11/IUER/LESSEE: CaNTRACTOR:
!{Jame, <eA114.I , I.. kk<—1 Ax^ .,;, Name•. /M -"/i r /&-,7Da J
Company:
art- � ': °u cc State: F� "Address S. S v, i J .
-
;Zip Code 3 �f .93 Fax:: Cityt:.�1't V Y'. Stater
l?hane:No077 aZip Codex . L l tJ'. Fax:
E Mail �??. 1.r wSC`��%•Q� Phone No/� al,a `,f�
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Fill in fee simple Title Molder.0n next page{ if diffQ.rent; E-Mai!
frnrnthe Owner listed Aw"e? State or.County Ucense C✓l G. i"Z S Cn
If value of construction is Z50Q or more, a RECdRt [dD Notice ot'Comritence.men . [s required;
'if Value of,.HAVC.is.$7;50t) ormare,' a RECORDED Notice o#Commencement Wrequtred:
QWNER CONTRAORAFFIDUIT:=Appticatowdntwmt �tndicated,
t.cerd thatnowork::orinstailatton,fiascommenced,pn�orto:theissuancecf'apermi.:
wrucNrwt�. u tawNtR. Xourfadure to,Record a Notice of Commencement mi tsuit rn paying twice for
irnprotiements to your property A Notice of Commencement must be recorded m the,pubHc records of Str
Lucie County and posted orn the jobsrte;before"the first rnsPectian If Xou.intend=to obtain financrn,,, rroc�sul€'
vurth lendero`r.'arrattorne `bef6' 'cdmmdndn ;woricor:cecord'n :':dur:Notrceof-Comrriencement:
51` nature: _
ner/ Lessee/ContFactvrasAgentfor Ownec 5tgnature.o _ontr cjllcense Holder
STATE OF FLORIaA - STA'fF"OF,'PLOfIDA
C0 TY":oF : �'t �
COUNTY
Elm
wom to or a rrtne )art su scn. e e are me v-: 5w n to;{or affirmed) and subscr+bed be ore me of
__ _ _ Physical Presence or. Qnlme Notarization Piiysrcal Presence or OnUne Notariztiort
this; j day of 202 . by this, day of 2aZ� fly
Kk
Narneofperson , akingstatement. m':o ame.of;personmaking ,tatemettt, �; m
R'JQ
N , Resonaliy!(nown•.. OR Produced idendficatton',`.ersonalayKnown C)RProducetl,`identitcation_
Cjrpe of Identif cadQit �, a �'ype of identification ►- ,
Produced L i o: F "o.Fodu ed o .
_
w; z.�
• �1AT
{Signature of Notary Public- t a orf y (Signature of Notary
) �
Pu" i Stale of FI , da: ).
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>Cordi tsslon No. - . _ - _ �5ealj .� i3 Comrriission;No K (ea ;
tiEVitUt75 FRONT ZONING S-URERVIS,OR PLANS UEG,ETATION SEA TU)TLE MANGRQVE.
CQUf)ITER :REVIEW REVIt1fU : REVlEUU- ; REV(EIN REVIEW REVIEIIV
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:DATE
RECEIVED
-.COMPLETED.