HomeMy WebLinkAboutpermit application 04-07-'17 10:50 FROM- T-707 P0001/0003 F-984
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l r
Date. 'Permit Number•
4
4
ouiiaing rermiT Applicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fart Pierce FL 34.482
Phone:(772)4621.553'FBX:(772)•462-1578 Commercial Residential
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Property Tax ID#: ' �e7 • "llyt [3-[?x-01. .tea+p,:..Jr' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:' Right Side: Left Side:
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AC Gas Tank Gas Piping f1_Shutters ElWinddws/Doors
Electric Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ Utilities:LJSev er'FISeptic' Building Height;
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Name Z-A N I-t C7 ZIRIaW Name: '>=£6' Grn61
Address: '2ki 16 " Z F-L-C_9-4 • �PC- Company: GLeaAv X&' ICC,+,+�l7oL�iFS
City.-.R)67 Sk Lorai; State: Address: lS? rlE/'YI�Y 12• _alpeL.�
Zip Code:3 k 1i b Fax: City: AV-7-St- t_U C,t d State: 15 ,
Phone No.V60- &02 (o Zip Code:. 3c/95'2- Fax:
E-Mail: Phone No. P06 i
Fill in fee simple Title Holder on next page(if different E-Mail:_PL[�grcJ r$7 S_ /QOL. e o m
from the Owner listed above) State or County License: 4CA C-v 64 660'
If value of construction is$25Q0 or more,a RECORDED Notice of Commencement is required.
04-07—'17 10:50 FROM— T-707 P0002/0003 F-984
DESIGNERIENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: - -.... .
Address: Address:
City: State: City: State:
Zip: Phone: Zip; Phone:
PEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Neale• Name:
Address: Address:
City. City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.J ucie Counter rreakes no representation that is granting a permit will authorise the permit holder to build the subject structure
which is in conflict with any applicable Nome Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Horne 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 worts
In accordance with the approved plans,the Florida Building Codes and St Lucie County Amendments..
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessorystructures,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 your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commen cin work or recording our Notice of Commencement.
' s
Si a of ownerAessee/Contractor as Agent for owner Si of Contractor/License older
TATE OP FLORIDA 'STATE OF FLORIDA
COUNTY OF 5"r Lu c.i F- COUNTY Of S. Lw c 1 Cosa .�
The fo ping instrument was admowledged before me The forgoing instrument was acknowledged before me
this day of g,t _, 20L—Lby this -7 day 0f i L ,20 Li-by
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(!Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary Publi -State of Norida) (Signature of Notary Public-State of Florida)
Personally KnOwn Notary
Produced Identification Personally Known L"eO'R Produced identification
Type of tdentifi duced Type of Identification Produced
"` � . SAN R�WAI.SM
Commission No. _ �. : 5Ea3) Commission No. a0.Y°"b
L COMM SSICiN#FF091118 f 10 SANOA WALSk1
jsc"?' 'd��^F CPIRI=S April 11,2018 � "; My COMMISSION#FF891116
r407j SSMI53 Fieridallotaly3ervice com '?p�J'w EXPIRES April 11,
2015
P,evised 07115 fa("M 153 r-+oaeallo $Mice.com
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