HomeMy WebLinkAboutBuilding Permit Application Miranda Plumbing&AC 7728710863 p.2
ALL APPLICAPLE IM Q MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
31
Building Permit Application
Planning and Development Services
Building and Code Regulatlor?Dfvislon
2300 Virginia Avenue,Fort ftrce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
EERPERMIT APPLICATION FOR: To Select from dropbox, click here
PROPOSED INPIkOVEMENTLOCATICN'
P
PROPOSED
Le� 1 scriptiorr
Me
Property Tax ID#: 3'US' -70-3 CZ6i n Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:_Right Side: Left Side;
DETAILED DESCRIPTION OF WORK!
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L4 I I _ffanlAlc :c:a
CO STRU, ON.-INFORMATION'
–Adiditico)na,��orktobenertormea nde!r this Permit–check all apply:
HVAC ]' GasTankF_JGas Piping —Shutters Windows/Doors
7
Electric Plumbing FISprinklers ElGenerator Roof
Tatal Sq,Ft of Constructl So.Ft.of Firs�t Floor:
Cost of Construction.,$ lh� Llti lities:13 Sewer Ej Septic Building Height:
OWNER/LESSEE: CONTRACTOR.:
Name Name, 0'A_7T_ ��kk
Addrew` � *Y�e C_-_
Company\Vi lu�OLEVhOk-r
C fty.- it tatL AddyAddrfts' t'Witl x)nI
r State.,
Zip Cod Fax. city
Cod
ZipCode:'2'L4%G;
Phone No, Fax
E-MailP
_jC�'LAf Phone No.
Fill in fee simple Title Holder on next page if different E-Mail:1) a �Le_\Cqmkig�_- L�co
from the Owner listed above) State or County License:(' AC-k9k5"4U_'0
If value of construction Is$2500 or more,a RECORDED Notice of commencement is required,
Miranda Plumbing&AC 7728710863 p,3
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SUPPLEMENT-ALN'STRUCT(QN LIEN LAW INFORMAT(bN: :
DESIGNER/ENGINEER:; ____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: i Name:
Address: 1 Address:
City: i City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certifythat no work orinEtaCation has commenced priorto the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which Is in conflict with an applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult wth your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting 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 5t.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures"swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to youi7 property.A Notice of Commencement must be recorded and posted on the jobsite
befor a first inspection, if you intend to obtain financing, consult with lender or an attorney before
commenWng work or recording our Notice of Comm, semen
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Signature of Owner/Agent/Lessee Signa resSf` ontradarJLlcense Hoiden
STATE OF FLORID STATE OF FLOKI A
COUNTY OFA , L i �- COUNTY OF `` - . IC .
_ 4lyitttt!!!
The for in instrument vAras a knowled ed before me,.``"`:"'"1�
g ,ayyQ The forgging instrument was acknowledged before me ; ;• �M
this�Y of ? L�Z� 20 by 4: r�I this l day of p� } 201Mby
? q% 0c,,-" t1 %"M1'•' rya
70 1
Lb V?,C 0 r��11 ,li �
(Name .person acknowlddging)
per fon acknowledging)
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Signature of Notary Putik-Sta a of Florida) 3 ' ( ignafure of Notary Public- ofi
State of da,J`
01
Personally Known OR Produced Identification Personally Known—OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.EE-i G3 (Seal) Commission No t, O S (Segal)
Revised 07/1512014 l
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REVIEWS FROMZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTIR REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE l
RECEIVED
DATE 1
COMPLETED
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