HomeMy WebLinkAboutBuilding Permit Application ALL APPIICABLE INFO MUST BE COMPLETED FOR APPLICATION TO-BE ACCEPT
IED
Date• I I I��I WAS Permit NuAer.
Building Permit Application
Planning and DevelopmentServica
Building and Code Regulation Division A
23W Virginia Avenue,Fort Pierre FL 34982 11 '
Phone:1772)4621553 Fac(77'x)40-WS Commercial Residential_
PITAPPUCATION FOR: To Selectfrom dropbox,.dick arrow at the end of line
OSED IMPROVEMENT LOCATION: _ -
Address: E avitaYdo Ciro- 1=-- R gr C'e- FL ?2q°►51
Legal Description: kY1��bY 1 12-e$ �G iVLI�IU�S
Property Tax lD#: _ Lot No.
Site Plan Name:�l"-(hYA I V 1 �G P CILBlock No.
=Project Name:
Setbacks Front Back Right Side:: Left Side:
DETAILED DESCRIPTION Ot=WORK.
- - e
CONSTRUCTION INFO RMATION::
AddMonal Work to be
ne rine under is permit–check all tWapp .
HVAC F Gas Tank QGas Piping _shutters om indows/Doors
Electric . Q Plumbing 0spriniers. OGenerator E
. 10 Y Z 0` 7M y .Ft.of First Floor.
Total Sq.Ft of Construction- -
Cost of Construction:$ 1 , 200 Utilities:USewer O Septic Building Height 1
OWNER/LESSEE CONTRACTOR
Name Kirhmal t 'T0YY%N\f(,kY' °(ZpM Name: C
Address: &ln e,.Cxyx-� o _ Company: c K -
_ State: Address- C 3 h.-
Zip Code: �1 Fa=c h Ciy: �f [cp— State. 1
Phone No.,A(C)�n11 '� 7.�p Code: �!�� s Fa= 7 926
E-Mall: {N�w Phone No.
Fill in fee simple Tide.Holder on next page(If different E-Mail:
ce ecu �tl
from the Owner fisted above) State or Cou "cense:
V value of construction is$2M or more,a RECORDED Notioe of Commenoement is requmed.
- i
DESIGNS ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
Clty: State: Crty: State:
Zip: Phone: ZIP: Phone:
FEE SIMPLE TITLE HOLDER:• ' _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name'
Address: Address: -
City- t it r, -
7ap: Phone• Zip: Phone:
1 certify brat no work or installation has commenced prior to the issuance of a permit
St Wde County makes no reps�on that is granting ape_rmit will�ugtorize the holder to buEri the subject ructure
widch tr in eorrfiict with ar�Y appG Home Owners Ass on rules, or an eovenarns that may restrict or prohibit such
structure.Please consult w .your Home Owners Assodation and review your deed r miry restrkdons which may apply-
in consideration of the granting of this requested permit,i do herebiragree that 1 will,in all respects,perform the work
in aoo.d..with the approved plans,the Roil&Building Codes and St Lucie County Amendments.
The foilowbtg bull ft permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structuresy swimming pools,fences,walls,signs,stxeeRroonand accessory uses to another non-residential use
WARNING TO.OWNER:Your failure to Record a Notice of Commenoen d may result in yourgayirtg twice for
im rovements to your prQperty.A Notice of Commencement must be recorded and hosted on the jobsite
before the first Inspection.If you Intend to obtain finaconsult with lender or an attorney before
commencing work or recording your Notice of CommenoeM
Signature ofOwner/Agent/t seeiijR&re of Co HoVa
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF ". �.: . COUNTYOF �Cc,�
The forgoing irwoum�rit was admawledged before-me The instrument was admowkAged before me
, dayof 1U6
tms� 1/' .2p by thi -of Ml✓ " .2QA by
A W p ln�A j 4jj;
(mm of person admowlWng) , (Name person )
( of Notary Public- of Florida) re ofNotary Public-Aft of Florida)
Personally[Chown_, P duped Identification Personalhi Krwtrttr_ OR Produced Identification
Type of Iderrd99 � Type of Identifi r
Seo"�S "�¢a, a SNA INGRAM ,aub, LA
«o:
Notary p ` Pu •, Notary Public 9 of Florida
Commission No. y State of Florida Commission N0. ;_°� _ (St
•« My Com omm.Exp.es 20,2018
xp res Dec 20,2018 -
�-49 �s° °04 Comml°sion ay FF 177249
Commission#FF y f7
Ya ora otaryAssn. ,,. _ .
Revised 07/15/2014 y '` " --,, s
REVIEWS - ; FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
'COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INRIP►tS - - - -