HomeMy WebLinkAboutBuilding Permit Application �I
1 1 1 � 1 1 1 .{ ' { r 111 1 • 11
• 1 •' • • •
Date: Permit
. � Number:11
BuliciffigPermit 1
plicatidn
PlcynnW and I- - rr
BuildIng and Code Regulation DIvIsion
2300 Orginia AVEnue,Fort
Phone:
• <• <62-1578 Commercial ■ _si
•ential
PERMIT
. 1 Y ■ / FOR:
M
r�l3+a !n � • � ,�4� � ® �.piTJ^a... aY,1e,.t't��br�
CP.?!51 n 4. S
Address 110=0
Legal . �r '� • +j.. .r
Property Tax ID#:
Site Plan Name; Block No.
, ,
Side:Setbacks Front Back: Right Side., Left
'-a: 1`!r:' �"".+>:'�`rY.3.°7` o'rf�-. ,<f-,i TK �: ;iu• y'cr�J%,s!n'rri,..Ft�;w..m'pp,.r .�.: x,..,33.;9,^,}' `, .4 LrU- j,,7rSt,�--qtr,„.��q.>�, wy„ a J,,.r,`;�h>,:,,t.;,,w
1.
'�5 Ja e '1 J' e',Y� '}Jrr,.k T,t�r �'-,jt•1.' �S;. r'�a,�cif' �:� !•�;ri�+'t�n�� M 5�� A $w ty a:�r�?1. �k s.,T'j�'.!tyN
”.® z A �,�;m�{s n � � �a J`tn�,�• r I t„� Il?"fir.4 E�:lp,t4 r �f nfS �,ry,-. �i'Il `u SI. r i <R •i J1 .Y,.c`r';3,_r�3w.. 'fit I ;F �'9.
� iA J4 7� A 7`l D't � ! ' }•�,�}"'uilrnkTkiIUIC�I��,!.:!��w^v��1w�rf�P.�?'� t"17 +,��er£' ��'.i� ..:1.�•f'.• ' 1 �v�l,� y':
c
i�'w' ?na v` '�°i'° !'' +i Il; •a�hi :,°'e�,e:'�.:, i."
S�,•.i0-:,
�"�� � o '`� e ► � �1'ylnn.rz.!l i��:gkG;rW"t'`viS�° .P� td�' ,lval j r a t��y,A-.J �•-� l.`� nt. NJr `M� +
fF'�P.tiii�' �,,� "GT•�1 �� `..� at�+��"r���Ll� �rY�d�''� t'xu.."�7�t'�1'T�3uki'��.n"'.kd�'<t���,�P.� �a,�i�7`l�r,:�r�'iia%':�tr.'ck1,+::`r�:Jn!�,"��k�:•:,�t�;��S�'a6�1:':�4�"�.v'S�e��:(,f'��'�Y'ri��'�,>�a��Jmi'�:;y,
Additional wOrkto—b—eDiertonmed uncler this permit—c EICKulnQ14PLY'
Gas Piping Shutters I Windows/Doors
OMVA( Gas Tank'
Electric Plumbing 05prinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First .•
Cost of Construction:$ utilities: Sewer D SlIeptic Building Height:
Name
Addres
Zip
J
�,(d y] ¢ (, � �'lJL�J�A1w.{�' �fu�{�L y�J�fi',!�(�.(j'y /e�y fry„L }� ��7L H�•J4�]
���J� ��vY.µJ!`@rVt� •°�urlf���.l��-1�lu1�i.[�.v�'JC�W=I.�ll`�L:r�r�JII�;LI.IYfA".L•.L'l� �J1+ �.. �� �tt�K ��"I1� I r� ��Y1'f]��1KA��'{ I TY� TCIiT:
�.a. w k,,,�a'�h• +Tt, a •ila�� it u t�.,�m,c(� r I l.s.,.,r r h:,.a., R.,wuu,
Code:- r
�i .
�l l� :1
HolderFill in fee simple Title ,n next page(if different ................ .. 'C� • ar
from Owner listed above)
'Jill / . •
i
UAN-16-2018 MON 03:34 PM CENTRAL SCHEDULING FAX No. 3212686138 P- 003
I �
u- �{;.,•.� n,..vf'_, i�;:gti..vv-'r,�„ ,ice °m.......k II ` .,S' A��,
"^7.e.+�,1• 'a:�r t / a 9y7 },. 3= 'T�' .:�,.. �7e , ,1 f i M'.
DESIGNER/ENGINEER: _Not-Applicable MORTGAGE COMPANY:I! Not Applicable
Name: Name: U_'
Address: Address: II
City: State; City: IIii State:
Zip: Phone Zip: hone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: '' _Not Applicable
Name: Name:
Address: Address: II
City: City: II
Phone: Zip: Phone: li
OWNER/CONTRACTOR AFFIDVfT:Appilcation is hereby madeto obtain a permAo 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 makes no representation that is granting appermit will authorize the permit holder to build the subject structure
which;is in conflict with any applicable Home Owners Assoclatlon 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 wh#may apply.
in consideration of the granting of this requested permit,l do hereby agree that I will,in all respects,perform the work
In accordance with the approved plans,the Florida Building Codes and St.Lucle County Amendments.
The following building permit applications are exemptfrom undergoing a full concurrency review room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessary uses to another non-residential use
I I:
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 Commencement must be recorded'and pok d on the jobsite
before the first lnspectiorn. If you intend to obtain financing,consult with'lender'or an attorney before
commencing workor recording our Notice of Commencement.
Signature of 0 erf Lessee/Contractor as Agent for Owner signature of ii ar/License Holder
STATE QF or
STATE OFF ARIDA --
COUNTY OF �1 - AAl�v�y...----- COUNTY OF
The'forgoing instrument was acknowledged before me The forgoing instar e t was acknowledge before me
this ay of 2 I ,by t 10 d ay of V`��14 A 20 by
Name of pe n making statement Name of person making statement
Personally Known OR Produced Identification Personally Known �OR Produced Identification
Type of Identification Type of identificatlon r
Pro ced Produced II
CAI
(Signature of 5i nature of Nota Public;S toFlorida
(Signature of Notary Public 5T< ,)or f g r1+ A Fl
e ger II i, r Catherine KonW
Commission No ?�an#FF17372 ' ;
`� ., ;= Commission N6. L _bion#pF172372
s QG`i'29,zol8 a` . = Expires:OCT 28,2010
HONDEDTHRU i' 80NDEDTHRU
�+un+,• ]STFLOIt1r1ANOTARY LLG 4
I p 9ai�,,•,+• 1.,TKLORIDANdT GLC
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION :Ii , MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE i
COMPLETED
Rev.8/2/17 I'
I,
• i ,
I I •,
I