HomeMy WebLinkAboutVargas Permit App (FP)All APPLICABLE INFO MUST BE CC) MPLETED FOR APPLICATIaN TO BE ACCEPTED
permit Number.
Elate:
Building Permit Application
p�orinjrrg -orrd De vel-opmeri � Services
Building on d Code Reg U10601', Da vision
2300 Vf rg+nia Avenue, F.Ort pierce ft 34982
Phone: (772) 462-1553 Fax: {7721462-1578
Commercial
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION'
Address- _ r
Property Tax ID ##; - Site Plan 'Name=
Froject Narne: -
DETAILED DESCRIPTION CF WORK:
----------------
A N � .-4 cim I n q
v
r�
New Electrical meter Seoand Electrical Meter
CONSTRUCTION INFORMATION:
Reside-ntial �V/
Lot N
Block No.
Additional workto be perform-ed under this permit- check all that appiY;
i echanicM _GasTank —Gas Piping—Shuttefs �1f z"!
Doer � Per d
�
_ Electric plumbing _Sprints lers _ 6enurator : oof �Iipitch
Total Sq. Ft of C[)nstruction. 5q, Ft_ of First Flood:
Cost of Construction: Utilities, —Sewer _Septic Building Height
OWNER/LESSEE:
NarnP- M tiMIL
Acid re ss;
City: F
Name,
Company -
State • L I Ad dress,.
Zip Code:? _ Fax -
Ph one NO- _7 I- ~
Fill In fee simple Title Holder on next page if different
City:
State:
Zip Code: Fax:
Phone No -
L
E- aiIL f
fro m th a Own of I isted a b eve) I state or County Liitan!K
if as lue of con st ruction js 2500 o r m ure, a FIiECORDED N of Ito of commencement is regU I rod,
if value -of H AVC is $ t,500 o r mo re, a RE CORDED Notice of COm iris nCe me Mt is requi red
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER- Not Applicable
Na rile:
Address:
City: State.:
ZIP' Phone
FEE SIMPLE TITLE HOLDER: �A of Applicable
Name;
Address-
City -
Zip: Phone:
MORTGAU COMPANY: lot Appiicahle
Name;
City: _
zip: —.
State:
Phone:
BONDING COMPANY,
Warne,
AddrCs5;
City:
Zip: Phone. -
I
.t Applicable
OWN ER/ COI TRACTO R AF F I DVIT: Application i s hereby rn ade to obte i n a pe rmit to do the work and fn stal ratio rk as i nc i c.ated_
I ce rtify that n o wn rk or iris[ a I Wtiran ha s cornmen cad pri or to the i s sua nro of a pe rmit,
St. bucie Cou nty m akes no reprcwnta tion tha t is gra nting a perm it will aut huriz e t he a rr'n i t holder to build the subject structure
which i s i n comf I ict with a nor a pplrc a ble H ornc Own
ers Association r ules, bylaws or a nseco�rc rya nt-5 th at may restrict or prate ibit su c h
st ru ctu re. P Lease consu I t wit h you r H orne owne rs Associati-on and nevi ew you r deed for a ny rest rictron s wh ich may a pply.
I n cc nside rati on of t he gra nti ng of this requ este d perm i t, I do h ereby agree t hot I will., wn all respects, perform th a work
in accor4lance with the approved plans, the Florida Building Codes and St, Lucie CountyfArnendrnents.
The fo IlavAng bu i I d i ng perm i t appl icatio ns are exempt from un d e rgoGng a fu II concu rrency review. room -a dd iti ons,
acre sso ry stru cturesr swi mrn i rig pool s, fences, wa I I s, sign 5, 5c reen roe m s and a Ccessory uses to a noth er n o ri-resid errtia I use
WAR NIN TO OWNER Your failure to Record a Notice -of Commencement may result in pay[ng twig for
improvements to your property. A Notice of Comrnencernent must be recorded in the public records of St.
Lucie counter and qosted on the jobsite before the first inspection. If you intend to obtain financing, cons-ult
sari#h lender or an rney be -tore q omm encing work or recordAR tour Notice of Cornrnencernent.
r
Signature cf Owners fsseelContr for as Agent for Owner
5ignatureof ContrEictor Icertiie H0Ider
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ... i
� .��
COUNTY OF � .
Sworn (or affirrnad) and subscribed before me of
Swor or affirrn-edj and subscribed before me of
_ li sl e I Presence �$ r D rrli rie Notarization
P h y� i-cal Pre5e nce -or Online Not rr atl on
this day of iCf l r 202-1 by
this day of sY� . 202 f by
Barn a of p erson m a ki ng statement.
N-3 m a of person ma k i ng statement,
Personally Known _ _. R Produced Ide ntificat iu n �
Personally Ian -own OR used lde r,tq facatao n
Type of identification
Typeof Identification
Prone
Pro ced
1 r _.
mn-m
(Sign tuie of blot ry P u blit-
nature of Notary Public. State u
r Ni1� Pub6C �1a9e Or FI B
Co m mission N c_
,}�' Notary P��li� lace
miss -mission No- I e� � Ile S
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REVI EVE
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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