HomeMy WebLinkAboutBuilding Permit Application ALLAPPUCABEE INFO MUST BE COA EEM EOR APPEICATHM TO BE ACCEPTED j
Dane: PermR Numbeh. ��Q S"0`t�_
Building Permit Application
P/annhig and Devdopmentserv7M
Bu kft and Code ftubtkiiDhWan
23ttD i�rxttn&►Avenue,FartFienae R 34982
Phone:(nz)4s2� �(772)462 s -Commercial Residential
PERMIT APPLICATION FOR: To Selma from droplmx,dick arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:-
'Address �t3 ST, la CeIr
lesal Desuiptian:
Property Tax ID#: -- Lot ft.
Site Platt Name- BlockNo.
Project Name:
p Setbacks Front Bads Rtght.Side-' LeftSide:
DETAILED DESCRIPTION OF.WORK:
CONSTRUCTION INFORMATION -
Addalonal work to tindlerthis permit- a . ap . .
HVAC GasTank Piping _ _Shutters C]VVh%dovwqW=
0Electric 0 Ptumbins nSpr"rs o Generator ORoof
. y f
Total Sq.Ft of Construction: Sq.Pt.of First Poor:
0
Cost of Construction:$ c7� S C� utiftm Usewellseptic Building Heq$ht
OWNER/LESSEE.- CONTRACTOR:
Name Cj Name: ... k
Address Company: c ,, k
Ctly: " Address: j
► :...3 Fax: 1� '�M r:_�f (C.�i Stabe+_IG
Phone Na �S?o /'~ r'c'�1'r� �f �. �-= MP Code: " - -Fm 27,2-- W&W
E-Mail; Phone No. 3 b
FM in fee simple Halder an next page(ff dlfferetYt E-Mail:
from the Owner lha d above) State or "Dense:
Ifvahre of construction b$2300or mar%a RECORDED Haft of1,w1111ptisr .
t
fr
O ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applcable
Name: Name:
Addr+E Address:
GAY: State: 0W.—
State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:- ' Not Applicable BONDING COMPANY: Not Applicable
Name.•
Address: - Addr+ess:
City. -
Zip: Phone: Zip:
1 cartifythat noivwk or ikon hascwnmwwWpdortothehsuanm of a permit.
St Lucie makes no on that is=AsmC=i
,w.ii�ll a the ho to build the subject structure
Whkh WithHome ilMfir�� M aft qts tnSy reSb O {� tltStiClistructure. t3osrodt tyour Home tton and re+row your lead r airy whkh may apply
fam"ationafthewaaftafthisrequestedpenuk I do hereby. gree that i will in all f perform the work
Ir!aaordance with the approved plain the Aorhla Building Codes acid St:Lude County Amendments.
Thepew aFF areexennptfrom undergpirrgaful!concurrency re+dew:room adftor4
aooessory s swimming poor facet waw sdgre;screer,.room�asd ammsoryuses to anottw use
WAlWU1DGi TO OWNER:Your faRrre to Re Dost a Noche ofGatt�nt may result in yours tate for
imppr'�iavementsto your prQperty.A Notice of Commencement must be recorded and posWd on the jobsite.
befoie the first Inspection.If you intend to obtain�M*en%gft'ent,-,-)
consult with lender or an a#tonuey before
oaminenci work or recordin Notice of Co
t -2�
Signature of Owner/Agent/Lessee Sk ature of CoMrracdoT Hoiden-
STATE OF FLORIDA STATE OF ROMA
COIIMYOF ` �. ,� 1 COUN1YOF_
The fOrph Instrument was admawiedged before-me Im fore ft instrument was ac mowledged before me
thlsl6_day of JDQIL _r 20$Dry tlris day of 'n by
1 (ftine ofF�aur�n9j ofad +► j
Y -
of Notary pift--State of Florida) {S ry of Notary Public-s Ftofide 3
Personally Known OR Produced motion P it Krown_ OR ProdtwW IdaWkaWn
Type of identification produced Type of Iddon Produced
Conunbsion No. (SmQ Commission Nrr.1 ,
Rivised.07115/2014
REVIEWS FROM' ZONING SUPERVISOR PUM VEGETATION SEATURTI.E MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIMS
1
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