HomeMy WebLinkAboutBuilding Permit Application Miranda Plumbing&AC 7728710863 p.4
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVE
Building Permit Application
Planning and Development Services JUN 16 2015
Building and Code Regulation Division
2300 Wginla Avenue,Fort Pierce FL 34982
Phone.,(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click here
PROPOSED IN PRO-V* EM* 'ENT LOCATION:-,
Address-q&:��y� el yl_f�,a G,
Legal Descriptlon:01 " o( � PI1 EP
GC oa-vi
Property Tax ID#, i9 Lot No,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:_Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRgCTi0N'INF0RMATION'
AdditionaKworkto be e orme un erthis permit-Eheck all that appy:
HVAC 0 Gas Tank F]Gas Piping Shutters Windows/Doors
13 Electric E Plumbing []Sprinklers Generator Roof
Total Sq.Ft of Construction:-- So.Ft.of First Floor:
Cost of construction: �3):K M Utilities: C Sewer 7 Septic Building height;
OWNER/LESSEE: CONTRACTOR:
Name 'ih e-r4,4 oe— Nam C.-A-1 T . k Qftf Y-AC k
Addr �C`4 (c, rin(lp.I 1cv Company:`
orn pa ny kA 11 e%f\AvLV(U 11 ar(ofk 14.4
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City.INV*�q.AIULr State Addr I
Zip Cod Fax,_ CitY-P0,r*Q_L1,V-i 1-3 State:F,—L'
Phone tt- ---g '104naTT. I , _' -_7
o, Zip Code-/,24 P
Phone N o._�f� W_-05-11
Filt in fee simpletitle Holder on next page S if different E-Mail: txY\ahtA-\
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Miranda Plumbing&AC 7728710863 p•6
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S.UAPLEMEN ALC S7 .UCTI6414#`N�LA1N.l.N :Ot2(�� N.
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DESIGNER/ENGINEER " Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phol e: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: ,Not Applicable
Name` i Name:
Address: ! Address:
City: f City:
Zip: Pha e: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or intonation has commenced prior to the issuance of a permit.
St.Lucie county makes no{epresentation that is granting a permit will authorize the permit holder to build the suoject structure
which is in conflict with an pplicable Home Owners Association rules,bylaws r and covenants that may restrict or prohibit such
structure.Please consult w th your Home Owners Association and review your doeed for any restrictions which may apply.
in consideration of the gra;ting of this requested permit,i do hereby agree that i will,in all resp ects,perform the work
in accordance with the approved pians,the Florida Building Codes and St. Lucie County Amendments.
The following building peal it applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools,fences,wails,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OW NEO:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to yours property, A Notice of Commencement must be recorded and posted on the jobsite
befor e first inspection. if you intend to obtain financing,consult with lender or an attorney before
cornmen jng work or 4ecording your Notice of Cornmenceme �.
Signature of Owner/Agent)Lessee Signa fess ntractar/License Holder
STATE OF FLORIDA4t` STATE OF FLO�R[7A ^+
COUNTY OF ' {Ll. CJ` C COUNTY OF.
y AINt
The f ing instrum nt Jas acknowledged before mega��s:Nof., .•`��o h tt,,z
The for ting instrument was acknowledged before me `41 nr.
this ay ofd 20 by _ this day of ';=� _20Gby
L,
"S�)0 n, U Ji Act
(Name of person acknowldad ing) o {Name of p,erson acknowledging) •• c—o
41 f Zm
o" 9
�Sr' ~�'wss►
(Signature of Notary Public-State of Florida) o o (Sig azure of Notary Public-State of Florlda)
Personally Known OR Produced identification Personally Known �R Produced Identification
Type of Identification Pro uced Type of identification Produced
Commission No. f (Seal) Commission No.��J�-.9(-3s (Seal)
Revised 47/15/2014
REVIEWS FRON ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUN R REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE .
RECEIVED
DATE
COMPLETED
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