HomeMy WebLinkAboutBuilding Permit Application ti
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit NUm:ber- J.",1 11-05,34
L�6 _109
tsunaing rermit i4ppince-noh
planning and Development services
Building and Code Regulation DAWDn
2300 Virginia Avenue,ruft Pierce R 34982
Phone:(772)462-1553 Fax-(772)462-IS78 Commercial 1 Residential'! If
PERIVIII APF UCAlfUN FOR: To Select from dropbox, elicit arrow atthe end of line
PROIJOSEU Ii PROVlz-JVlLN-I LOLA I ION'
Address. S q g
-
Legal Description,
Property Tax I D C401_-Q QC!i^� Lot No.
Site Plan Name, Block Na.
Project Name:
Setbacks Front� Back: it i
R ght Side. Left S
1XI AILED L*K,-9IVI ION 01-WORK:
ILk
�Uc ONINFORMAT104'..
oij-al-wif—orkto- bp-e-noo-riEr-rF-rn-e-d--u-n-ffe—rtK permit-c" heck ZQJ�applvt,
ri Gas Ton Das Piping F71
qH'VAC k _Shutters Windows/Doors
Plumbing [J Sprin klers Roof
IlElectric Generator Roof pitch
Total Sq.Ft of Construction* SQ.Ft.of First Floon '
Cost of Construction:$ utilities:LJ sewer[]Sep'tic 'liuilding Height
OW-NER/LESSEE:
_-
Name C& Se L VAAD-C Name,--
Address: 5r-1 i Company: O(A5-re,nn. A r r S't-is erka
City: State:AY Address! Agl-:f
ZipCode: city,
Fax: Pop-r-20ti, L ur_t�
Phone No. (0q,5-_ci!>2tS_ Zip code:
E-Mail: Phone No, Til 1 335 - S 3 1
Fill In fee simple Title Raider on next page(9 different E-Mail. C U S t aL I't' ig s Gc n 1.C 6 VYL
from the owner listed above) State or County Lice"nse:
r value of construction is$zwo or more,a RECORDED Notice of cammeac&nent is required.
t
j r I
r
DESIGNI<E? EhIGEIkIEER: _ Not Applicable MORTGAGE COM jANY: Not Applicable
Name: Name: i
Address: Address;City: State:State: City: I State:
Zip: Phone; Zip: Phone;
FEE SIMPLE TITLE N ODER: Not Applicable BONDING COMPANY: Not Applicable
Name: � !Name:
Address: Address:
City: City: I
Zip: Phone: Zip:_. Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
I i i
St.Lucie Countyy_makes no representation that is rantinga ermitwill authoriue the permit holder,to buildlthe subject structure
which is in con, with any,applicable Rome Ow ers Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply_
In consideration of the granting of this requested permit,I do hereby agree that 1 will,in all respeets;perform the work,
in accordance with the approved plans,the Florida Building Codes and St.Curie County Amendments,
The following building hermit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wails,signs,screen rooms and accessory uses to anther noxi-residential use
WARN ING TO OWNER:Your failure to Record a Notice of Commencement may result in your'payutg twice for
improvements to your property.A Notice of Commencement must be recorded and pasted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender of an attorney before
commencing work or recqfding your Notice of Commencement.
i
� � 5
Signature of Owner essee/Contractor a$Agent for owner Signature of Contra rfLicense'ttalder
NATE OF FLORIDASTATEOF FLORIDA,
COUNTY OF '+ _ _ Uel E'. COUNTY OF
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this l day of A.!t>;v,e t�,t> r" , 20 Eby this t 3 day or tsvcor�a'z ,20 �,by
I
• u r i<!$ taF`t S _ Lt.t t st9 m Mori S..
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Fla) (Signature of notary public Stat of F1'
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
j Type of Identification Produced 'type of Identification Produced —
j �
li Commission No.ll"1 n o:5 k 6 melt mission No. l�2 ' � ��`1 � � t+Yti::� i G{6
x * MyL'17MN allml i 1rm y` * c: )21
_.._ ,•., 2OZ —_.—_ � i68tu. w-�eFi91NEn`��1 'c �`r . Erdcrt
4aWwtfw9uEpM�Y •""'s ^
.. � �* * �Y��Md>+l�Stf7trt�G648i2Si8
Revised 07/15/2014 i R2D2s
I — ,
REVIEWS FRONT ! ZONING SUPERVISOR PLANS { VEGETATION SEA TURTLE MANGROVE
COUNTER i REVIEW REVIEW REVIEW REVIEW
REVIEW REVIEW
!SATE
COMPLETE _
!
INITIALS
I