HomeMy WebLinkAboutBUILDING PERMIT APPLICATION4.
All APPLICABLE INFO MUST BE COMPLFTED FOR APPLICATION TO BE ACCEPTED
Date: loll a I Permit Number:
��111:��iw LL- I CVL�
Building Permi4 Application
Ptanning and Developtnent 5ervices
Building and Code Regulation Division
Z300 Virginia Avenue, rart Pierce Ft 34982
Phone: (772) 462 -15 5 3 Fax-. 17 7 2) 462 - 15 78
(.-ommerclal
GBDG Funding
RE?Slde[ltlal
- . . ........
RI'T APPLICATION FOR: NvE4C Q�p\occ-crtt��
�-*. - - ....... .1. ..... - - - . ..... ----- .... . ... . ..
PROPOSED IMPROVEMENT LOCATION:,
jF &
Ad d ress:
Property Tax ID #: 4 Ao ;1C
Lot Nop
Site Plan Name: Block Nop.
P roject Na m e L
'P
Q- - - -------
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION.
Addt'tlonal work to be
performed under
thils permit — check all
that applyp
,KI(Aechanical
-- Gas Tank
Gas Piping
Shutters Windows/Doors Pone
E I e Ct r i C
.-- Plumbing
ITotal Sq. Ft of Construction,
Sprinklers
G ever at o r Roof Pitch
Sq. Pt, of First Floor:
rust of r-onsitrur-tion, utilifies:
- -- - - - ---------------
Sewer - Septic Building Height: _ —.1
.. . . . . . ....... . ............... . ........
4j OWNER/LESSEES Ca�RACfOR:
i'Narne" 13g
Address: LA Amdm&3L I city* St ate
A CA Fax:
1! Z i- P c4de;
Phone No. 2. t E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner fisted above)
Company
Address:
"---D - V
V nL� State. L city -- fa'.n
Zip Code: q ?)4C F
A0
Phone No` _
E - P" i I U i a:k
.State or County Li }.a Ar 0420stA
If value of con str uctl o n is 2 500 or more, a 8 ECOR 0 E D Notice of Com men cerne nt is required
if value of HAVC Is $7,500 or more, A RFCORDS D Notice of Commencement is required..
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
dt5IGNER%ENGINEER: Not Applicable
Name:
Address.
CitV:1
zip: Phone -
FEE SIMPLE TITLE HOLDER:
NameAddress.'
;
i :
1 r): Phone
.. Not Applirab l
•. .. ...Y ...�Wf�OQiP'�la+�rtf�
-- ..�.�.. - �... ..... _.....
r............ ._�--�••rn� W�l��.
MORTGAGE ECOMPANY: ---- Not Applicable
Address,
0t;
zip: Phone!
T.�n�....._.....—.._.�...- �... m.......
�-...
BONDING COMPANY. Not Applicable
Name:
Address-
0 0 tv._ t r
zip: Phone:
OWNS CONTRACT 1 D IT* Application is hereby made to obtain a permit to do the work and Installation as indicated.
I cortify that no work or installation has commenced prior to the issuance a permit.
St. Luc i P Cou my maktis n n rp(ir P se ntation t h at is gr a ruing a permit *111 aut h ri a the pe. r m it holder to bu i Id the subject structur
Wh I ch con flicts with a n I i c able Hom eowners Assoclat ion roles bIa w5 or and cove n do is t hat m ay re. Strict or prohibi t su c h
structure, Ptease consult with your orne ners Associatton and review your deed fo( nY restrictions which may apply.
In conside ra t on of the gran ti ng of t h i s req ues # od permit, I do hereby agt -Pp t o t I wil I, 1 n a I I respects, perform the work
in accordances with the approved plans, the Fiorijda Ruii ing Codes and St. t urge Counter Amendments.
The fniaowing buil ing permit appiIcatio r s are
exempt from undeorg
Mng a full
C()n( urre. n cy review: room
addltions,
accessory structures, swiprnming pools, fences,
walls,
signs, screen
rooms and
accessory uses to another
non-re.sidentl8l use
WA R N I N G TO OWN E R : Your fa (lure to Record a N otike of Corn mence nt may re uM t in paying tMco for
iri) rove meats to your property. A Notice of Commencenient must be recorded in the public records of St.
'Jirie County,in,ind posted u n the Jobsite before the first inspection. if you intend to obLain filnancin&consult
abefore ' work or
_ ....._........... ...._..... ....
i n a t ii re of ow nor Lessee/Contractor as Agent foir Omer
STATE OF FLoR aA
couMrY OF �-
Ora to (or air r e) and subscribed ba fore me of
t - - - ,Q�g,, 20&)1 by
i
P—sonall r Known �,�.¢vv✓� ..�OR Produced Identification
PT Id entJ Produced.,.-
Phys4ical presence or • T•_-.,, online Notarization
L _, ...` —�—. /_ 1►�Y Afit, _ EMMA PARILHUR5T
( Egn e of'Notary Pu bf(-
I
. Commossion No.
E iEw
I )ATE~
izrr
L DATE
COMPLF1 E D
R-6-5-7072._.
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COUNTER
Mate G1 1 �. -
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ExOres October 20,2024
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