HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST 89 COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: i,.
II II II III .
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
•2300 Virginia Avenue,Fart Pierce FE 34982 I,
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Resitlential
i PERMIT APPLICATION FOR: To Select from dropbox, click arrow ai the Enid of line
address• Tr!mTalIN
Legal Description:
Property Tax ID M v I �' I'' Lot No.
Site Plan Name: r Block No.
I.
Project Name:
Setbacks Front_ Back: Right Side: Left Side! i:
i.
Additi
na work o e e orme un er is perm --c eC aMe'——
appy: {
0, HVAC O Gas Tank Gas Piping tters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
i
Total Sq.Ft of Construction: 5El.Ft.of First Floor: 11
Cost of Construction:$ Utilities: Sewer Septic Building Height:
l
Name Nar !� r
Addre Cor4any:
Fe-r;Wr n
City: c Stater Address:
Zip Code: Fax`:- 0. City: State:, ,
Phone No. `l Zip Code, ti i Fax:
,ry
E-Mail: �} Phone No. 7 3q �. _.1 .
Fill in fe simple Title Halder on next page(if different E-Mail: !aLoss�55 � �
i
from the Owner listed above) State or County Licens"LL2�
L
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required,
I ,
i,
i
I
DES11 ER/ENGINEER: Not Applicable MORTGAGE COMPANY- Not Applicable
Name: I
Name.
Address. Address: i k
City- State.-__ City: State:
Zip: Phone Zip:_Phone: I i]
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: __,,Not Applicable
Name: Name:
Address: Address:
City;. City:
Zip, - Phone; 1,
zip: Phone: 1
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the 'Work and installation as indicated.
I certify that no work or installation has commenced prior to the Issuance of a permit,
St.Lucie County h a th Id
3make norepr representation that is granting a permit will aut iorizat eg per o arto build the subject structure
which is in conflict wit t an 21 fe I
J�applicable Home Owners Assoc arlon rules,by aws or an covenants that ma�,restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
I Irl,1s
in consideration of the granting of this requested permit,I do hereby agree that I will,in all respet ,perform the work
In accordance with the approved plans,the Florida Building Codes and St.Lucie County Ar'endmiiks,
The following building permit applications are exempt from undergoing a full concurrency review,!room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residentiai use
I I I;
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result,fiv your paying twice for
improvements to your property.A Notice of Commencement must be recorded aii'd posted on the jobsite
before the first inspection.if you intend to obtain financing,consult with lender or,a"an attorney before
ommencing/work orpecordinizvour Notice of Commencement. ,h
6fo
T
$Ign 0 ei�/Lessee/Contractor as Agent for,owner SiSI contractii Licens'',,Holder
ST F FLORIDA. E OF FLORID�
CT2NTiYIOF LUCIE-
COUNTY 01CEG
.The fo Ing instrument was aFknowledged before me Thef in&ins tTument was q(lknowledge d-before me
thts;TTdayof 204 by this May of20 by
Name of personpoking statement Name of perso making statementPersonally Known V_OR Produced Identification Personally Known ollProduced Identification
Type of IdeWication Type of Identification
Produced-, -Produced
CPAG A.GRC MAN lima
CMJQ A.0111
MYCOMMISSIONO PF9892
W 00MMMM"10N
I 1139 -
(Signature of Notary Public- ARA PIMAS =e of Notary ii blip-st&e C AM-
AL
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ,'REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17