HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number_
Building Permit Application JUN 2 s 2017
Planning and DevelapmenrServices
Building and Corte Regulation Division
2300 Virginia Avenue,Fort Preme FL 34982
Phone:(772)462-1553 Fax:(772)ase-mss Commercial Residential
PERMIT APPUCATION EOR: To Select from dropbox, dick arrow at the end of One
PROPOSED 1[tRiPROVEMlJ11T.LOCATION.1
Address: 3 C -r r AA-
Legal Description,
Property Tax ID#; �U,2 - Sly CJ 7 G fJU Lot Wo_
Site Plan Name: Block No.
Project Name:
Setbacks FrontBack: Right Side: Left Side:
�..
Rid
PETAILEMDES R {O °C�FPT
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remove existing pedestal install new
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CaNSTRIJCTI�N�II!IFOR Tl
zona wo e net r R- un er allis perm —civacK all appy:
13HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
21 Electric El Plumbing ❑Sprinklers OGenerator 12I1oof
Total Sq.Ft of Construction: Ft.of First Floor.
Cost of Construction:$ f��G 0� Utilities: Septic Building Height
OWNER . . _
Name .'�,��a �l f T�-h s, Name: John R Law
Address: S3? Ale- f is a c,�Z Company: Lavws Electrical service Inc
City: (?eA GZ, State: Address: 5158 NW Priann St
Zip Code: S7 Fax City; 17r ST alae State:FL
Phone No. l fo ��U `� (0 2�' Zip Code: Fax:
E-Mail: Phone No.772 370 4357
Fill in fee simple Title Holder on next page(if different E-Mail:johnlaw5l58@aol.com
from the Owner listed above) State or County License:29432
If value of construction is$250D or more,a RECORDED Notice of Commencement#s required.
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DESIGNER/ENGINEER; _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City State- Qty: State'
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER-. _,Nat Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Addre=
City: City: -
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit
St Lucie Countv makees�no representation that is granting apermit will authorize the permit holder to build the subject structure
which is In contictwith any applicable Home Owners Associatlon rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home OwnersAssociation 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 respells,perform the work
in accordance with the approved pians,the Florida Building Codes and St Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fines,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure t i 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 vvith tender or an attorney before
commencing work or record' our Notice of Commencement.
s
—Signature dwner/lessee/Agent Signature of Can ctorllicense Holder
STATE OF FLOR - STATE OF FL
O
COUNTY OF �. lP COUNTY OF
The foreoing instrument was acknowledged before rile The for'aoing instrument was acknowledged before me
ttls,,2aday of 'i"fir . 20 1'?bg this a day of '3vrr.g 20 Eby
(Name_gf person acknowledging) (Name qfVerson acknowledging}
(4A-P /X Ut4AII Af&-f,
(Signature of Notary Public-Stat Florida)
(Signature of Notary—Public-State of Florida)
Personally Known _OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification lAroduced
Commission -�-� �`� Commission No. P�� (SeaQ
ANNE GROWN WALMACH .�`"`-..
SSW f-^ A hliks-
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA � GR4VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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