HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INIF0 MUST BE COMPLETED FOR APPLICATION-to BE ACCEPTED
Date: 0 Permit Number:
tsuming reirmn Application
Planning and Development Services
Building and Code Requ/660A Oftion
2300 Virginia Avenue,Fort Diene A 34992
Phone,(772)462-1553 Fax: (7721462-1578 Commercial Residential
PhKMI I APPLICA I ION FUK* To Select from dropbox, click;arrow at the end of line
PHOPOSEVIMPROV,LMENI LOCA110k:
Address:_ 700gZ e1r
Legal Description:
Property Tax ID 4, Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back., Right Side., Left Side:
1)k t AIL11) L)L-% 'RiP i ION 01-WORK:
11-re- IYSee-r J"'V -p,
I-ONINFORMATION:-
Adclitlonalwomto!JLL-pe rme -th
M I —rto 0 U—Nddt is permit—crieckbil
14�\JHVAC Gas Tank Das Piping "Sbutters, D Windows/Doors
nElectric Plumbing Sprinklers CGenerator Roof Roof pitch
Totaf Sq.Ft of Construction: Sq.R.of First Poor
Cost of Construction:$. 9 ,-- Utilities: Sewer ElSeptic Building Height:
0VV-NER/LESSEE: . 'C014TRACT0R:' --.--'
Na-me, h1f.h, Name. C, U 12-r r 5 "A M Vk C,r?5
Address, N,9 si t n I W16-fag 1 L&,4 V
_nr 103 112 Company-, C95--rnm A %r- S,Usi,-Msin:C;
QV. shdfho ----S6W Address: I I ag--e r ee rt
Zip Code: — Fax: \S—V)LAZA.A: city- flo PLT- ge.-L Oct V-
State-.A-
Phone No, _ f 7a -9 -065 Zip Code: r-ax: 435196Y
E-Mail. Phone No.--- '/'];L 3a -
g5)-31
RJI In fee simple Title Holder on next page(9 different E-Mail: a_k $t ek I r- 9 41 s p a o I.!Cefy—A---
11rom the owner listed above) Smote or County License, C o 5 1
It value of construction is$2500 or more,a RECORDED Notlm of Commencement is raqukwl,
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY., Not Applicable
Name: Name;
Address: Address:
City: State: City: State:
Zip: Phone: Zip:—Phone:
FEE SIMPLE TITLEHOLDER: _Not Appffcable BONDING COMPANY: —Not Applicable
Name: Name,
Address: Address:
City- City:
Zip: Phone: Phone,
I certify that no work or installation has commenced prior to the Issuance Ufa permit.
SL Lucie Cou*makes no representation that is grantin�,a permiturill authorize the permit holder to build the subject stnicture
which
1
wh is in con ict with any,applicable Home. Owners As aciation rules,bylaws or an COVenants that may.restrict or prohibit such
structure-Please consult with your Home Owners Association an&revieitv your deed for any restrictions vihicb may apply.
in consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance vdith the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exemptfrom undergoing a full concurrency review:room additions,
accessary structures,mwimrrfing pools,fences,walls,signs,screen reams and accessory uses to another non-residentialuse
WARNING TO OVMER.Your failure to Record a notice of Commencement may result In your paying twicefor
Improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection.If you intend to obtain financing,consult with tender or an attorney before
commencing work or rec inLour Notice of Commencement.
Signature of Owner/lessee}Contractoras Agent for owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The ing instrument was acknoviledaed before nie The forgoing instrumenj was acknowledged before me
this'170day of d 20f bg this 15:1 day a
r_)Va P' 20/ 7 by
eu rin Mori 5' t
eu IZ*T'i 3 . ..'$d M mo 1`1
(Name of person acknowledging) (Name of person acknowledging)
:f�4
I
Stat of F140r,
9�f� iK
(Signature of Notary Public-State of Fico a) (Signature of Notary Public-stat Flor
ric
OR Produced identification Personally Known OR Produced Identification
Personally Known w V_/
Type of identification Produced Type of Identification—Produced
VNCommission No-Cn�7OPMMI No. Mull
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Rmised 07/1512014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REviEw nEviEw REVIEW REVIEW
_DATE
COMPLETE