HomeMy WebLinkAboutBuilding Permit Application r
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 b �1 Permit Plumber:
RECEIVED AUu loll
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2,100 Virginia Avenue,Fan Fierce FL 34982
Phone;(772)467-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow attthe end of line
qAddres$: Y� '
legal Description: .QQ �
Property Tax Ib#: � �-0 0"0 Lot No.
Site Plan.Name: Block No.
La
Project Name:_
Setbacks Front Back: _Right Side: Left Side;
-mal R � 3
5 7 ht<r .
"O'naor o e Orme un er t is permit—check all t=appy:
AC ' Cas Tank DGas Piping ;Shutters o Windows/Doors
Electric Plumbing Sprinklers Generator g Roof
Total Sq.Ft of Construction: So. Ft.of First Fluor:
Cost of Construction:$ I�o.00 Utilities:0Sewer 0 Septic Building Height: _
Name Name
Yl
Address:
Company: rbw
City: State:R Address: 15k W cfly
Zip Code:„ � Fax: �0 City: .Sttaate: Fl—,
Phone No. Zip Code: Fax:
E-Mail C 'I Phone No. SVT
Fill In fee'' ple Title Holder on next page(if different ' E-Mail: 1 :
from the Owner listed above) State or Co my License:
If value of construction Is$2500 or more,a RECORDER Notice of Com mencement Is required.
DESlQNER/EN 'INFER: Not Applicable MORTGAGE COMPANY, Not Applicable•
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:
City: City
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Count�make no representation that is granting a ermit will authorize the permit holder to build the subject structure
which is in canfllctwi any applicable Nome 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 granting 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 permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wall's,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
commencing work or.recordin vour Notice of Commencement.
�A�ORIDA
r/L ee/Agent $!gnarOF
nt ctor/License Holder
5TORIDA
COUNTY OF ` LI-LC i COUNTY OF
The forgoing Instrument(was acknowledged before me The forgoing instrument was acknowledged before me
this J. _day of A _ 20 12-by this_J�_day of 20 1Z.,by
(Name of person acknowledging) (Name of person'cknowledging)
(Signature of Notary Pub/llo-State of Florida) (Sig ature of Notary Public state off Florida)
Personally Known- .v OR Produced Identification Personally Known _OR Produced identification
Type of Identification Produced Type of Identification Produced
Commission No. Ofa9 Commission No. )0 r ea
LOUDE '0
KRISTINA L tdUDERB CK
7!/,
tt+ttr COMMMI
1tg 009222 'sons. EXPIRES Atsgaat 7, 7
Revised 07115/2014 , EXPIRES August 7.2017
tan asaoisss or�rs .•
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REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
LCOMPLETE
INITIA S