HomeMy WebLinkAboutjohnsonALL APPLICABLE INFO1 RUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: alo—q.
Building Permit Application
Planning and Develw4'nt services
Building and Code Reg t. ion Division
2300 Virginia Avenue. rt Pierce FL 34982
11,
Phone: (772) 462-9:59',
59', Fax: (772) 462-1578 Commercial Residential
PERMIT APPEIi.AT ON FOR: To Select from dropbox, click arrow at the end of line
Address: I L ()
Legal Description:
Property Tax ID
Site Plan Name*
Project Name.
Setbacks Front
Back: Right Side: Left Side:
AaarcLpriai WOM 10 ge FIVITTIVU Ullu=1 U11a U11111L Ju,:J apply:
[
HVAC
L'� Gas Tank 17Gas Piping Shutters 9
Electric Plumbing OSprinklers F]Generator
Total Sq. Ft of Constru4on: Sq. Ft. of First Floor.
i!
Cost of Construction: $ Utilities: []Sewer
Septic
Name 1�- U I -J- NJ (-,4 L.4 �, I (-,/u I N" —fL11 —D
I Name:
Addrey: l l
CompaM.Jf,3KJn
city:\ -JF— 4��F_� I State: -F
Addr _ss: q40 \1
1
Zip Code: ACTS' Fax: k,�
Co.
Phone No. 1
OD
Zip Code:
E -Mail:
Phone Ro.
Fill in fee simple Title HIder on next page (if different
�bove)
E -Mail: r_ff_WA1")4
from the Owner listed
State or County License:
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required
Lot No.
Block No.
Windows/Doors
Roof
Fax.
State:
.,4 —
..........
DESIGNER/ENGiNEE Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: i' Address:
City: is State: City; State:
Zip: Phone: Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: — Not Applicable BONDING COMPANY: _ Not Applicable
Name. Name:
Address: Address:
City: City:
Zip: Ph 'ne: Zip: Phone:
i certify that no Work or i4stallation has commenced prior to the issuance of a permit.
5t. 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 a applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult ith your Home Owners Association and review your deed far any restrictions which may apply.
In consideration of the gra sting 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 peri nit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swJrr 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 ycu 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
commencinR work or recording ygiur Notice of Commencement.
Signature of Owner/ Agen,/ Lessee Signature of Contractor/License Acilder
STATE OF FLORIDA j /��'p� STATE OF FLORIDA
COUNTY OF I (v!�jl� V I COUNTY OF _
The fcg ing instru t acknowledge ore me I The f >ing ins u w s ck owledge fore me
this day of 20 _y this day of 20
I
(Nameo erson ackn (Name o er ack ledging )
of Nota Pu ic- State of ori a Si nature of Nota Pu I' - a f FI rid
(Signature ry ) { g ry }C State � )
Personally Known . !OR Produced Identification Personally Known iy/ OR Produced Identification
Type of identification Produced Type of Identification Proclucp d
Commission No. ' 2-G/ 15eal) Commission No ` %
CRYSTAL MA IE CRUZADO
rp # Ff9932t
'c MY COMMISSION # FF993217
Revised 07/15/2 1 EXPIRES June 25, 2020
'Ao .�?' EXPIRES June 25, 2020 aw aseeiba Pier
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