HomeMy WebLinkAboutBuilding Permit Application ALL APPUC, LE INFO MUST BE COMPLETED FOR APPLICAMON TO BE ACCEPTED
Date oy��Q� '
Permit Number: / D
r I ,
Builditig•permit Application
Planning and Development servIces - AUG 10 2017
Building and Ode Regulation Division
2300 Virgin! Avenue, Fort Plerce F4 349$2
Phone: (77 462-1553 Fax: (772)4624578 Commercial Residential l/
PERMIT-A PLICATION FOR: To Select from dropbox, click arrow at the end of line
16
Address: "���}yY;'
Legal Descri on:
Property Tax #: 1
Lot No,
Site Plan Na
1111 ,.,f� Block No_
Project NameC��'1 �-�,.z.. .•- �`
Setbacks f' nt_ Back: Right Side.• Left Side:
NNE=
re >nc e(vr, or &50 0, N tktC+f-le
Y)C*
Addi Iona -wo k to er orme un er
t Ispermit—c ec -a appy:
HVAC s Tank I'�1Gas Pi In _
L_J p g Shutters Windows/Doors.
Electric „Plumbing E Sprinklers Generator Roof
Total Sq. Ft of Eonstructlom S .Ft,of first Floor:
Cost of Cons tr ttion:$ � Litilities: Sewer Septic Building Height:
Name Name:
Addre - Company' 1( is
City: a'' State:J _7U Address:
Zip Co d e IQ Fax City Stat;
• (
Phone No, - 'Zipco e: Fax: • —
E-Mail: Phone No,
Fill in fee situp a Title Holder on next page(If different E-Mail: �rCAON PN
from the Own r listed above) State qr County License:
If w1ue of const u[tion is$2500 or more,a RFICORDED Notice of commencement Is required. �+
i
p.:lilJf,M1 fi��iijv<
DESIGNER GiNEER: —Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name. Name,.
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE ITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip:. _Phones
i certify that I
k or installation has commenced prior to the issuance of a permit.
ISt.Lucie Coune$no representation that is granting a permit will authorize the ermit holder to build the subject structure
is in coith any applicable Home owners Association rules,bylaws or an covenants that may restrict or prohibit such
structure.Plesult with your Home Owners Association and review your deed for any restrictions which may apply.
in consideratihe granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
In accordancehe approved plans,the Florida Building Codes and St.Lucie County Amendments.
The followingng permit applications are exempt from undergoing a full concurrency review:room additions,
accessory str ,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING ti'ItNER:Your failure to Record a Notice of commencement may result in your paying twice for
imp ovemeyour property.A Notice of Commence ent must be recorded and posted on the jobsite
be f a the nspection. If you'mend to obtain financl ,consult wit lender or a»a Corney before
tom encidin r Notice of Commenc ent.
Sign at re of a see Sig a ure o Co tra ce se Hold
r
SWAT OF F RID OU E O OFORI£!___
Cou O —.�.-----
The forgoing i tr merit wa a nowiedged,,�ggfore me The f r Ding instr a was ackn wiedged efore me
this_I o 20�sitby this day of, 2e ,1 Y
(Name of p acknowiedgi
{Name of perso cknowledging)
Ror
ignature tary Pubiic--State of Florida} ( lure of Notar ubiic-State of Florida)
Personally Kno n AOR Produced identification Personally Known Produced identification
Type of Identifl tlo _ Type of identification Prod e
��j! ,��t "p 6�. oJFaAiYNNERussee1.
�+f 1ERAly�iM SoftC d.- .�. r Commission No. 'n Y'sr -5tataofFlortda
N tar Pu e S n GG 087ga8
Commission N i Y Flori a =;�.�� � My COM.Expireslu122;�fu1
r � Comtrnssion�GGo67448 e
M/COMM Ex it wn.
Oadedthmugh NanonN NctaryAssn. ,
Revised 07/ ',5/2014
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS