HomeMy WebLinkAboutVanderpool Permit (5V St Lucie )All APPLICABLE INFO MUST BE CO PLET E0 FOR APPLICATION TO BE ACCEPTED
Date,
Permit Numbemr=
L- L 0 L U L, Building Permit Application
Mann ing and Devebpm en t Services
00(ing and Code RegLj1otj0r3 Di wrsior7 Commercial Residential `
2300 Vrrginio Avenue, Fort Norco FL 34982
Phone, (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR.
Address; '� LA
Property Tax 10 #; QL� 1 - — —1-1 Lot No..
Site Man Name: V Un C I- 1 - V
Broiect Name; N y 4 �-f _\ t" 1- i
DETAILED DESCRIPTION OF OFT:
y Q�L
j r
3� U�k-�Jj
New Electrical m � t r, r Second E lectrin I Mete r
CONSTRUCTION INFORMATION:
Rlock No,
Additional work to he performed undeir#his permit -check all that apply:
_MechanscaI Gas Tank _ Gas Piping _ Shutters : W1nclows/Doors Pond
Eleetrie _ Plumbing _ Sprinklers _ Generator Roof
Total Sq. Ft of Construction: I x q Sq. Ft. of Flr5t Floor:
Cost cf Construction- $ Utilities, —Sewer _ 5ept1r. Building Height,! �a&l
OWNER/LESSEE:
CONTRACTOR.
Name t f�
Namo�l
�W 1
IneA
City,. _ state: I
Address: R_ k e
Zip code: Fax;
City, ,1,z-� State.
P hone N 0
Zi p Code: q q q Fax:
E-Mail: • z_)�
Rhone Nod - 3'-4----7 us
EilI in fee sirnpialitIe Hol-der on next page ( if diff�rent
E-MaiI ' -
from the Owner listed above)
State or County Livens
If +gal ue of coast ruction is 25 00 a r ma re, a RE CDR D ED Notice of Commencement Is requ [red.
If value -of H AVC is $7t500 a r more, a R-ECOR D E D Notic a of Ca mmenc-errant is req u [red.
SUPPLEMENTAL ONSTR�CTJON LIEN LAW INFORMATJON:
DESI NEP,/ENG I NEER; Not App l cable
f� ORT AGE COMPANY: ' Not Applicable
Name;
Name`
Address;
Address:
City{: State:
City: State:
zip: Phone
zip: _ phone;
FEE SIMPLE TITLE HOLDER: Not A��I i �I a2
BONDING COMPANY: N of A Ppl icabll e
Name;
Narne: _
Address-
Addro55;
City: _ _
City:
Zip- Phorke.
Zips;. Phonic:
OW N EIS/ CONTRALTO R AFFIDV IT; Appl i cati e n i5 h ereby made to o bta i n a pe rmit to do the work and i n 5tal I at+oro a s in d icated ,
I ce r-tify t ha t n e wo rk or Installati-o n has com m e aced prior to th a issu a n re of a pe rmit.
5t. Lucie County makes no represen tati rm that is granting a Penn it will a uth on ae the erm i t holder to build the subject structure
which i s i n On f l ict with any applicable Horne Owners Association rules, bVl ews or a ns rove na nt s that may. restrict or prohibit such
stru ttrre. P� ease -con su I t with you r H ome owners Associ at -Pon a nd revi ew your de ed fo r any restriction 5 wh ich m ay apply.
I n con 5 i-deration of t he grant inn of this req uested pe rmit, I do he re by agree th at I wwill, i n ali respects, perform th a work
i n accotda noe with the approved pl arcs, the F Ior I d a Suil4i ng Codes and St. Lu cie County Am end rnerpts .
The ful l ❑wi ng buil d i ng perm it appl icati ❑ ns are exem pt from un dergo i no a f ull concur -re ncy review- roorn ad d iti o ns,
accessory str uctu res, swi mm ing pool sr fe nces, wa I I sr signs, screen ro orn r. a nd aceersory+ u ses to a noth a r n on-residentia I use
WARNI NG TO What N E R: You r fa ilu re to Record a Notice of Corry men ceme n t ,may r-esu It in p aying twice fo r
I
mprovements to your property_ A Notice of Cornmencernerlt must be recorded in the public records of St,
Lucie County and posted on the jobsi#e before the first inspection. If you Intend to obtain financ-Ing, consult
+pith leader on aA a ttorney before c om rn e nci ng work or re -co rdin or Notice of Corn rnenC-e-ment.
r
Signature of er Lessee contractor as Agent for owner
Signature aCtorf 1,'ce se HdIder
STATE OF FLli< DA
COUNTY �F
i
STATE 0 FLORIDA
COUNTY OF
Sworn to (or affirimed) and Subscribed before me of
`ariaaticn
Svl� to (or affirmed) and subscribed before ma of
PhysicM Pr ce or Online h
on
Physi{al Rres nce a Online Nritariaation
th i s I Ll d ay of �i , 21 by
this ,L d ay of 2I by
\h �75
N am a of persn n m a ki ng staterne nt.
N a me of pe rson Pn a ki ng statement.
�
Perso nally Known O R P rod used I d entific ation _ _
Personai IV Known OR Prod uced Identification
Type of I d crrtiftcation
Type of Ide ntl fl ratacIrr
Prod u d �
Prodd
i
L '
(Si nature of Notary Public• Stat
re of Notary Public- State of FI-arida �
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Commission Na. aal gas
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
COUNTER
REVIEW
R EVI EW
EVIEW
REVIEW
REVIEW
REVIF
DATE
RECEIVED
DATE
COMPLETED
Rev.