HomeMy WebLinkAboutBuilding Permit ApplicationMvST
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pyyCAFtiON Number,
FOFm+tper
BECOMPDL
pyyAPPIICASLE 1100
Date-.
; s permit pppiicat*
Building
r
and Development 5ervices pestilential --~ter
planning elation Division
Building and Code RegjerComlmelrclalror
2300 Virginia Avenue 5531 Fax.. 1772) 462-1578
phone: 1772) 4
PERMIT TYPE:
Address.
property -Tax ID 4.
Site plan Name.
Project Name:
SCRIPTION OF WQR.K:
_ �. t � 1 r•. r o 111 €�. b'L�
CONSTRUCTION INFORMATION
Additional work to be performed under this permit — check all that apply:
V" Mechanical _ Gas Tank — Gas Piping _ Shutters
Electric —Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
,-
5 2� ,
Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Yl Name:t 1
Address: D9 1+ G I t )USYN -- -- Company t iii— V �k s (-UI
City: �.� �!— _ State:
-LI— Address: f,
Zip Code: Fax: City:—
Phone No. �,q �2 3 �3- Zip Code.
E -Mail: Phone No7-4
Fill in fee simple Title Holder on next page [ if different E -Mail �_ ` o
from the Owner listed above) State or County Lice
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required
Stater
Fax:
' ��3 V
5 49t
DESIGNER/ ENGINEER: Not Applicable MORTGAGE COMPANY: � Not Applicable
Name: fume;
Address: Address:
City: State: City; State:_ --
Zip; 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 Couniv make no representation that Is granting a permit will authorize the permit holder to build the subject structure
which is in can ict wit any applicable Home Owners Association rules, bylaws or andcovenantsthat may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply, ,
In consideration of the granting of this requested permit, I do hereby agree that I will, In all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, wal(s, 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 Commencement must be recorded and posted on the Jobsite
before a first iris ection> If you intend to obtain financing, consul n attorney before
co enci�a"r_kp_o.r recon i ur Notice of Commencem
T Signature of:owner/ Lessee/Agent
STATE OF FL47Rl A
COUNTY OFF 4
The r oing Inrtru nt wris)ac know
ledger` hefore rs A
this day of ' A.
ZB (Y `ig
�w V_"Fr� n (1 /2
—
ame j person
of NotarV Public- State of
Personally Known �OR Produced Identification
Type of Identification Produced
Commission No. F --F7- j � . -7 (Seal)
Revised 07/15/2014
STATE. OF FLOR , r'
COUNTY OF t
The f a;ng ingtrurr � vis acknowledged before m � i �
this . J A r _ �'c .20 LLlav
Ow -AA cr, rAa
(Name ofO Orson acknowledging) -_
( gnature of N tary Public- State of Florida)��„����*`�
Personally Known 6R Produced Identification
Type of Identification Produced
Commission No. d-W'5-�I (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAINS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
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REVIEW
DATE
COMPLETE
INITIALS