HomeMy WebLinkAboutBuilding Permit Application 07/14/2017 15:21 7724663737 BOYLEAC PAGE 03
ALL APPLICABLE:INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEDEDr: Z
Date: d
Permit Numbe
wilding Permit Application
Planning and Deveiop►»enf Services
Building and Code Regu"on Division
2300 Virginia Avenue,Fort Pierre FL 34982
Phone:(772)462-1553 Fax:(772)452-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from iiropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 3dqcrll
Legal description: LQ we,
Property Tax ID#• %3 b 5-00 0 Lot No.
Site Plan Name-
Black No.
Project Name:
Setbacks Front -__.._. Back: Right Side: Left Side:.
DETAILED DESCRIPTION OF WORK:
wi h 501 $ack-.-LLP h2Q:.
CONST CTION INFORMATION:
AdLditignalwarktobenertormed undefthis permit- ec a app y
MVAC Gas Tank o"as Piping _Shutters ❑windows/Doors
Electric Plumbing []Sprinklers Generator ❑Roof
Total Sq.Ft of Construction: SnSeweroseptic
of First Floor:
Cost of Construction:$ �� Q Utilities. Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: Company: ( 'i L
City: BLA5 S State:Pi. Address •
Zip Code: Fax: City: State:
Phone No. Zip Coder JAI Fax:
E-Mail:_ W1A Phone No.-7-1 4(D 1,JRA-I. --------
Fill In fee simple Title Holder on next page(if different E-Mail:
from the Ciwner listed above) State or Co my License:
ff value of construction is$ZSW or more,a RECORDED Notice of Commencement Is required.
07/14/2017 15:21 7724663737 BOYLEAC PAGE 04
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
OFMGNE ENGINEER: Not Applicable MORTGAGE COMPANY: Not A►pplicabfe
Name: Name:
Address: Address:
City: State- _ City: State,
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name-
Address: Address:
Zip:. Phone: ---- �- Zi Phone:
I certifythat no work or installation has commenced prior to the issuance of a permit.
St �tie Cour�ty makr�na rep
n that is gran a it will authorise the permit holder to build the subject re
whlth Is In corrftict with ar►y appl le Home Owners A V8ed n rules,bylaws or an covenants that may restrict or iro�t such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may axply.
In consideration of the granting ofthis requested permit,I do hereby agree that 1 will,in all respects,perform tate work
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 camurrenry reviewer_room addictions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:You failure to Record a Notice of Commencement mtay result M 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 fender or an attorney before
commencing work or recording our Notice of Commencement.
1� AY ,c •. - —
signature of Owner/Agent/Lessee Sknatu%of ContrachwAicense Ho! er
SPATE OF FLO STATE OF FLORIDA
CAulw OF { t(1Q, COUIM OF
The oing InstrurnVat was acknowledged before roe The fo no Instrument was acknowledged before me
this day of TIA kk 20 ikbthis ay of ,20_W by
UAW r. �Chi 1-1 � �111,(C�/lQ.� � b (P� I� �
(Name of person acknowiedgin ) (Name of person acirnowled rrg)
�P
aj�- g, afo:::�a -
(Signature of Nota li of Florida) (Signature of Notary c-State of Florida)
Psrstxtally Known OR Produced Identification Personal
Type of I T)Fpe aF I iProduw15i{N �•
. � . t"AISTINE J.GOWtELjAs . ti 4
NN�, * .t � n; �yalun M GG
Commi c•Stajg5Wi % Comm issso • ' 9 o Exp{,eS AN
.* commitrion f GG 0178 , d, sandedrnrouph NationalNo FY#AIM-
°;,�•`� through Noional Wiry
it
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATnON SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
07/14/2017 15:21 7724663737 BOYLEAC PAGE 05
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