HomeMy WebLinkAboutBulding PermitALL APPLICABLE 114FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: w 1 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line (f'
PROPOSED IMPROVEMENT LOCATION:
Address:— I
Legal Description:
Property Tax I D #:
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Lot No,
Block No.
VX6�-
CONSTYILICTIONI INFORMATION
Adgifighal work to be performed under this permit –check all appy:
_ HVAC Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
I-JElectric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: _ Sq. Ft. of First Floor:
Cost of Construction: $ ' i100- -- Utilities: Sewer O Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name e 5
Name:
p/
Addres//s�: (P, AuUws
City: l�U puLii State: fl/
Zip Code: 3151 Fax:
Phone No. `719--q 2), 2125
Company: n Amino
Address: 51 A Tu.m p(la, 1%ee4 M' -
n
City:Q ((� Stater
Zip Code: 3`NtSI Fax: Z72 -ib& 4F31
Phone No. _11;1-4491 _4141
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: 61�/��
State or C unty License: M18 U b
If value of construction is $2S0O or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL t:ONSTRUiCTI N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name.•
MORTGAGE COMPANY- _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name-
Address:
Address:
City:
City:
Zip: Phone:
Lip: Phone:
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.
M—
s s subject structure
riot or prohibit such
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, wails, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Cormrmerim meat may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. if you intend to obtain financine. consult with tender or an attomPv hPfnre
of
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Canuactor/license Holder
STATE Of a s.
COUNTYOF $ y
The forgoing instrument was acknowledged before me
thisZ4 day of 20q by
Q -01 f
Name of peri aking tement
Personally Known OR Produced Identification
Type of Identification
The forrggoing instrument was acknowledged before me
this�20 day of �20jby
i_ ektl F.. Boyle.
Name of perso along statement
Personally Known OR Produced identification
Type of Identification
Produced
.0mmis '� = Notary Pu"" State o} I r' a
iublic # GG Ot a Commis
'�OT�� My Comm. Expires Aug 21, 2829
A t"` Bonded through National Notary Assn.
REVIEWS EftONT UPERVLSOR PIANS
COUNTER1�0�Nl
REVIEW REVIEW
I COMPLETED
Rev. 8/2/17
t:MMISTINE J. CONWELL
Notary Public - StateV6M)da
--Cammrs-sion # GG 017839
My Comm. Expires Aug 21. 202(
VEGETATION� SEA TURTLE � MANGROVE
REVIEW REVIEW REVIEW