HomeMy WebLinkAboutBuilding Permit App - DanielianAll APPLICABLE IWO MUST BE COMPLETED FOR APPLICATION TO BE AC PM
Date:. l , Permit Number:
12, t-,`-pLr{Usalea
�w�-k
V `' L M "` Building Permit Application
Suf AV mrd [bate Reiman Divi0= Commem-W Residential
Z9W W901aAveme, Fart Pierce F! 34982
Phone:1772) 462-m3 Fax: 1772) 462-im CBDG Funding
! PERMIT APPLICATION FOR: AS - -
PROPOSED IMPROVEMENT
Con . �. • .
Prop"Taxom- 4/
Site Plan Name:■ an it, •_ ■
Block No.
!, r ■r
DETAILED DEWMPTION OF
r
K a � i,:° �,, s a: e • i � , 's a� s ., � � ' t■ % ;rat
New Electrical Meter Second Electrical Meter (Affidavit required)
COAISTRMIpN INFORMATION: - — —
Additional work to be performed under this permit — check all that apply:
Mechanical f as Tank _ vas Piping _Shutters ., _ 1Mb4wAftors; ,•,,,_, Pond
Electric — Plumbing Sprinklers — Generator Roof Pitch
To#al Sq. Ft of Got ruction: 4109- Sq. Ft. of First Floor: _
Cost of Construction: I - !3 5,g , OQ Utilities: _•,_ Sewer _„ Septic Building Heim
OWNERAESSEE: --
Ne� �LiSL�tLtli4 ��.Dt3
Address: 1�r),'tiNn.1
Cit1►: _ INL1 U 64
Zip Code: 1j C1Qd _ Fax:
Phone No. -1-1 a - S 19 - . 2 q 4 Q E-
Mad: F- it s cdan i d irtn & Q t+A& 1. C gM
Fill in fee s&nple Tide Holder on next page (if different
from the Owner lis'ted ob wo
conmrarroR:
Name: Dal%A0 ( ,. ,
Compenr AM"-
L i, A {�
Address: 4261 sE
C ty: S Ao.E i- slate; r- I
Zipcode'. 34tl(tr'i Fax: �-
Phone No '1-
E-Mal an Ih CawQxtda"
State or County License -LA- r3 4�,q
if value of tons&ucdan is 2-or more, a RECMM ftft at Cmmencement Is re*dred.
R value of HAVC Is $7,500 or more, a RECORDED Notice of Commeacamw* 6 required.
SUPPLEMENt~ALCOMMUCTioN UEN LAW INFORMATION:
Dd—IGNERjENGINEIER: _Not Applicable I MORTOME ODWMY:
Name•
Address:
--
Zip: Phone —
FEE SIMPIE TITLE HOLDER.,
Name:
Address:
c1tv-
Zip: Phone:
_ Name: _
Address:
State: City:
Zip: Phone:
_ Not AppNoble
Not Applicable BOHNNG COhVANY: Applicable
Name:
Address:
- city: �-
- —� Zlp: Phone:
_r
OWNED/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and err as ineficaud.
1 cei0v that no work or Installation has emnrnenced prior to the Issuance of a peradt.
St Luce my makes no n that is ntinB a permit sudwite the permit holder tv build the s re
s njkP e ;�e Homeowners Association rules or arrts that srralr or��
Vow Homeoamers Association an your for 3my �i may
in eon ra*m of the granting of thb requested pert k i do hereby agree that i VAIL in all respects, perform the work
in accordance with the approved plans, the Fiorida auikimg Codes and St. Lucie County AmenalmenM
The fob building permit aWkwlons are exempt from undergoing a ** conamnarrct► review: room additioK
aecessory structures, swimming pools, fences, waits, signs, saam rooms and awessM uses to another nonileskierrt al lie
WARNING TO OWNER: Your fWkwe to Record a WaSm of Commencement may rearlt In Pftft twice for
improvements to your property, A Notice of Commencement must be recordedin ft public rt Aw& of S"G
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender of , ,: attorne before commencing, work or recording your Notice of Commencement.
I Signaww ConUateror - or - Owner Builder as applicable
SThTE OF FlARI �
COURN of
Sw nm [or afR ands bef m me of Physmi Preseam or Online Noun
this sU- day of _ by
ti� 1i:SG 11 (in I. -
Name of person making statement
Pe al Known OR Produ d tification
of cauan Prod—
r
i
tiro of tyatary Pahl ri ap
�58��5 } L-j;,
Notary Public State of Florida
ealCharmin D Walker
My Commission GG 225827 Expires 06106/2022
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