HomeMy WebLinkAboutproduct infoALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date;
Permit Number:
Building Permit Application
Planning and Development Services
Building orad Code Regulation Division
2300 Virginia Avenue, Fort Fierce FL 34982
Phone: -772} 462-1553 l=ax: (772) 462-1578
Commercial
Residential
PERMIT APPLICATION FOR: To Select from drpbx, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
7,2;T1 00201 111
Legal Description:
Property Tax I .
Site Plan Name. -
Project Name
Setbacks f=ront
�) OIS841
Back:
Right Side; Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Iditional wor
I� HVAC
Electric
4ti
Lot N0._ 6
Block No.
to be erforrrzed under this permit—check all that appy:
Gas Tank Gas Piping � Shutters � Windows/Doors
�y
�t.PlumbingSprinklers � Generator � Roof Roof pitch
Total Sq. Ft of Construction;
Cyst of Construction: $
Sq. Ft. of First Floor:
Utilities: Sewer Septi c
Building Height:
W N E CESS E E: CONTRACTOR:
r.
Na -
r
city State 4Address: L
r/\., It- Stage:
ak
Zip cle. Fax
Phone No.. � � , � � � Zip Code: _
'77
E -Mail.
Phone No. 77CU -
Fill in fee simple ie Title Holder on next page if different E -M a11:
from the Owner listed above) Mate or County License.
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DES I F ] NEER: Not Applicable
MORTGAGE COMPANY: Not App l is b le
Name:
None:
Ad d ress:
Ad d ress:
City: State:
City: ate
Zips: 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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in c�o ict it€� any applicable dome Owner Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consuit with your Horne Owners Association and review your deed for any restrictions which may a Ip ] .
In nsiderat o i f the�'antin ofthi' requested �3 �'�7;i�, i Ego hereby i ee thhat I NI, i aII respects), erfor i ts iNe VVI: 9 N
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The followings building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, sv°irnrin pools, fences, walls, 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 Commencementrest 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 cordin your Notice of Commencement.
Signature ofOwner/
STATE of FLORID
COUNT! OF
see/Contractor as Agent for Owner
The forgoing instrument was- acknowledged before me
this I day of 7T
r
(Name of e" on-aclno dgin�
ignature of Nta, 4sc- Smote of Florida
Per na'► *o%�� f WA
Typ �' n' is ICS
M
orr� # , `No.
EXP If May 1, 201'
C
Vri 07/15/2014
itification
I
Signature of ,ontractor/License Holder
STATE OF FLORIDA �,,� / P
COUNTY OF LGcc.4 'e
The forgoing instrument was a kno rledged before me
this I qday of D'V4M &2Z�, 20 by
(Name of
Signature of No
Personally Kn
Type of Ident
Commission
lnowled;in g
JF
bX- State of Florida )
�arr�
NV HAN RAYMOND FITZ PATR
1401139,S -W53
MMI
DE
NRES May E;?A J
FIiondallo,aNSarvke.cofr
S
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIAL