HomeMy WebLinkAboutBuilding Permit Application'I
ALL APPJid�''
ABLE. INF01 U COWIPLETED FOR APPLICATION TO BE ACCEPTED
Date: i Permit Number:
Building Permit Application
Planning and DeveloPrnle'nt Services
Building and Code Reg tion Division
2300 Virginia Avenue, Pierce FL 34982
Phone: (772) 462-15�� Fax: (772) 462-1578 Cor0mercial Residential
PERMIT APPLICATJ.ON FOR: To Selfrom dropbox, click arrow at the end of line
Address:
Property Tax! ID #:
Site Plan Name:
Project Name:
Setbacks Front
erzn, 1
A
Back:
LJHVAC "Gas Tank
1
Electric Q Plumbing
I J
Total Sq. Ft of Construcuon:
9 Cost of Construction: $
a
Lot No. __
Block
o.—
Block No-
Right Side: — Left Side:
L)
erm a
ernmm Ock aff apply:
c
Gas
z Shutters as Piping F Wind,6ws/Doors
Sprinklers Generator Roof
Sq. Ft. of First Floor:
Utilities: 0 Sewer I ]Septic Building Height:
Wl WMAlki 9 WFA WE
RON Z oil
from the Owner listed "Bove)
State County License: n
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required
Mr.AM��
DESIGNER/ENGINEEF :
_ Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address: is
Address:
City: is
State: City: _State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HO,'DER:
_ Not Applicable BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Ph ,'ne:
Zip: Phone:
I certify that no work or irlstallation 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 subject structure
which is in conflict with a applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the grating 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 nit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swirr ming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNS : Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to youf property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspe ion. If you intend to obtain financing, consult with lender or an attorney before
commencine work or ecordixle Your Notice of Commencement. _
Signature of Owner/ Agen'f/ Lessee
STATE OF FLORIDA —nOCOUNTYOF
f
I
The.forgoing instruent 14asacknowledRed.6Afore me
this day of
e
(Signature of Notary
Personally Known _
Type of identification
Commission No.
Revised 07/15/201
20 .�'�y II
+�kyI
aging) L
State of Flo id )
OR Produced Identification
iced _
/ CRYSTAL MARIE CRUZA
A4D41 FF 993
EXPIRES June 25, 2020
(407)39&0159 FWtd2N0l8rySemca.cM
Signature of Contractor
STATE OF FLORIDA f
COUNTY OF
Thg`` going in r t a acknowled efore me
this day of 20y
(Name of
(Signature of Notary Pu lic- State of Florida \J�
Personally Known OR Produced Identification
Type of identification Producednoo nmission NF_F(q
uc:524' j5
17
CRYSTAL MARIE CRLZADO
'V'-*ge' EXPIRES June 25, 2020
1AM1'%QA-n141 F4v1AnNMAru.SiFlNi[A CNn
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