HomeMy WebLinkAboutBuilding Permit Application 7728710883 p2
Miranda Plumbing&AG
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ALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01 Permit Number: IS
RECEIVED
Building Permit Application AUG 11 2015
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772�462-1553 Fax: (7721462-1578 Commercial Residential
PERMIT APPLICATION POR: To Select from dropbox, click here
PROPOSED INPROVEMENT LOCATION:
Site Plan Name, Block No.
Project Name.,
Setbacks Front_ Back!_Right Side: Left Side:
DETAILED.-D ESCRIPTION OF WORK:
Additional work to be rmed under eckalTthat apply*
LJ Shutters
0HVAC GasTank 'ff,8,rmP,p 1 nce Windows/Doors
0 Electric Plumbin,-, Sprinklers []Generator Roof
Total Sq.Ft of Construction: So.Ft.of First Floor:
Cost of Construction: Utilitles0 Sewer Septic Building Height-,
OWNER/UtS-EE: CONTRACTOR:
Name ( Name:
E-Mail: Phone No.
Fill in fee simpJe Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
I vaueo construction is$2500 or more,a RECORDED Notice of Commencement is required.
Miranda Plumbing&AC 7728710863 p•3
I
SUPPLElVlENTAL:C- NSTRUlt:T46N;�Lf.EN=LAW=IN
DESIGNERIENGINEER Not Applicable MORTGAGE COMPANY: Not Applicable
Name: I Name:
'Address: Address:
City: State: City: State:
Zip: Pho e: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: „Not Applicable
Name: Name:
Address: ? Address:
City: City:
Zip: Pho 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 in�taiiation has commenced prior to the issuance of a permit.
St.Lucie County makes no fepresentation that is granCing a permit will authorize the permit holder to build the subject structure
which is in conflict with an applicable Ftorne Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult w th your Home Owners Association and review your deed 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 respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building per' It applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swim Ing pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNiNG TO O1hWNE :Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before a first inspection. If you intend to obtain financing,consult with lender or an attorney before
corprnen jna work or eecor ingvour Notice of Commenceme
Signature of Ownerj Agen j Lessee Signa re-ifs ontractor/License Holder
STATE OF FL iD S STATE OF FLORVY-
COUNTY OF` 1 COUNTY OF i - }('t
The forgoing instr ment was gcknowled ed before me,!;IR k,, The for ing instru ent was a knowiedged before me W. °T c
this day of 4110 ijC,+_ 2d yby thisay of 01 2¢oil
PIZ
u § R5Z I
(Name of erson acknowiddgin j' m
M a { ame erson ac o 'tedgin ) i
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Z� 9N � �
0pu . �� J NNS
ts
(Signature of Notary State of Florida) a S is Signature of Notary Public-State of Florida) al cn�
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Personally Known OR Produced ldentffication Personally Known OR Produced Identification
Type of identification Produced Type of Identification Prodduced
r !
Commission No. r 09C (Seal) ! Commission No._ ��j; seal}
Revised 07/15/2014
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