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HomeMy WebLinkAboutBuilding Permit Application I All APPLICABLE INFO MUST E COMPLETED FOR APPLICATION TO BE ACCEPTED t' Date: 9 Permit Number: I1 0 �II III It 1111, II f Building Permit Application. Piannina end 0evelovnesir 5evices I f 3t:i1071V and Code RC!YW(7 iarr Division 2300 Vltainiv Ave,7ue,i-otr Pierce PL 34982 f Phone: (772)4.52-?SS3 fax: (772)452-'?573 Commercial -- _ _ Residential PERMIT APPLICATION FOR- Address, 01 CSI C I- _ ' Laic' �f'-YI k�'iL� D, II Legal Description: 1 Property Tax I# � }� (�}I � (� I Lot No.1� Site Plan Name; iBlock No. WA Project Narne: ( r � Setbacks Front Back: Right Side; Left Side: '11, it �; „ docr / 11 B AdclitionalwoMtobepertormed under this permit--check all that appy: ` „_Mechanical _Gas Tank � Gas Paging Shutters ✓ Windows/Doo-s Electric Plumbing Sprinklers _Generator, Root `atal Sq. Ft of Construction:./'�/'�II11 _ Sq. Ft. or First rioor: I Cast or Construction:S �'i`-~t V. Utilities: Sewer 00 Septi Building Height: i I Name Address: VUeLonipany: (rt:Y,a Ci#v. I Address; 1108 o c aeu& Tic Zia Code-_ dLQ Fax:�tfh ' city: Lnctian }�� �at� State:__! { Phone No._..�T( ( Q�"t� ? yip Code;_ 32 3 t� - - Pax: _3�!- �77- L{Z�� j E-Mail: XA - l Phone No. �7L-337- 710 Fill in feesimple Title Holder on next page (if different E-Mail: C L' 55h Ji.nr.- "i'' 11 from the Owner listed above) State orCounty Lice'SE; :�2" z)#q -- — _ if value of construction is 2500 or more,a RECORDED Notice of Commencettent is required. —� �I +r ii I I i it i I ESI6NER/ENGIlVEER: Not Applicable MORTGAGE COMPANY- Not.Applicable Na rIe 1 Dame: i Address: Address: 'I City: State: } City: ii State:_ i Zip: Phone: [ Zip:_ -- iIi Phone-,,I ; FEE SIMPLE TITLE HOLDER: Not Applicable ' BONDING COMPANY, ,i ;Not Applicable i Name: < Name: II Address: Address: l city: i Zip: Phone: Gip: Phone;{1 ! ii 'I i certify that no work or installation has commenced prior to the issuance of a permit. !� i St.Lucie County makes no representation that is granting a permit will autnori.e Fhe permit i al er to build cne suniect strinure which is in conflict with any applicable Home owners Association rules:bylaws or aria covenant's that nay sestricL or prohibit such structure.Please consult with your Horne owners Association and review your deed far any resxrictions which may apply. in Consideration of the granting of this requested permit, I do hereby agree that 1 will,in all respects,per form the•,cork in accordance with the approved pians,the Florida Building Codes and St. Lucie County Arrten.ments. i rfie following building aermft applications are exempt front undergoing a full Concurrency revie,:room additions, accessory structures,swimming pools,fences,walls,signs,screen roor 1s and acceS5ory USes to pnother non-residentia;use WARNING TO OWNER:Your failure to Record'a Notice of Commencement may, 111t in your paying twice for improvements to your property,A Notice of Commencement must be recorded and pasted on the jobsite before the f- st inspection. If you intend to rbtairi Financing, consult with lender or ar. attorney before cornmenci work or record's. o �r Notice of ccmmer!cement_ �'i j Signature of Owner/Lessee/ogent Signature Wof Contractor/ 'ichse.Holder STAB £OF FL IDA j STATE OF FL ID �I # COUNTY al= i COUNTY OF-���rC� —1`1 forgoing i s acknOw;adged' e4cr=.me I f e fol g4irrg i t we acknowledged before rine i this r 20 b} ; this ay 20 by I .i ! (N r rs a dgin (N o er c Ing, 1 { gn Lir P e Florida i r r a 'P' f(or!da i dupe a 'n wn duced lden_lfica=ion Per I d identification a Type ? Type ,. .I j Canmtsslon No. Commission. , MYCOMMISSION#FF244M55 *, ILIO KEBZ{G a MY. OMMISSION#FF2446 Rg„.•`` 9ondedThfuNofaryPublicUndewdfars } Revised 471.15 2 � ' ,J�Et�' 3cndYd7liruNofaHPulilk 49 1 I u detwtfisra `I• i REVIEWS FRONT ZONING ! 5LiPERV15c)R ?LaN5 1 VEGETAT!&N ! SFA TURTLE MANGROVE CCIUFtii7ER ; REVIEW REVIEW REVIEW REVIEW PREVIEW REVIEW f�A i E i C©MPLE i e INITIALS i II s' i� I( li iI