HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•
tSwKrog rermn Appllicaxion
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Fierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential (/
j FEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMI}KOVEMEN I LOC:AI ION: - - -
Address: 1 �l 51,�i� U
Legal Description:
Property Tax ID #: 3 a 10 - l l -, OCII- Oce -8 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
CONSTRUCTION INFORMATION:
HVAC L._1 Gas =. ank [_]Gas Fiping {L�_j1 Shutters
Electric Plumbing Sprinklers i� Generator
Total Sq. Ft of Construction: Sq. Ft.of First
jFloor-
Cost of Construction: $ 3 $S'b Utilities: Sewer I l Septic
OWNER/LESSEE:
Namacdfw)
Address: 18'Q S( 9iPpnrI RA
City: Font ljxLt, � State: FL
Zip Code: JlYW.T Fax:
Phone No. 77a - a I b -2 3 3 7
E -Mail:
Reit in fee simple Title Holder on next page ( if different
from the Owner listed above)
Block No.
13WIndows/Doors
0 Roof C� Roof pitch
BLiiding Height
CONTRACTOR:
Name: Ci; 'i i S 5,Aty,oAcet
Cowlpang: C)-STa ati A i r 5l: S t e%`KS it c
Address: tlYt5 �;f; ! dG ��FeerZ
t°o 2r St . L c State:
Zip Code: u-+175.2 - Fa)c `7'L2 3 .5-1
Phone No. 7 'I QL 3 3 5-
E-Mail:
E-Mail: C K s t cz 5 ?= G n L C G rrt
State or County License: ` hr LI? J i
if value of construction is $2500 or more, a RECORDED Notice of int is required.
SUPPLEMEN IALCUNS 1 RUCHON LIEN LAW INT-UHMAI ICON:
DESIGNER/ENGINEER: _ Not Applicable l
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State: ,
City: State:
Zip: Phone:
Zip: Phone:
t =
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable i
Name:
Name: I
Address:
Address:
i
City '
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit_
St. Lucie Countv makes no representation that is granting a permit %viii authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure_ Please consult with your Home Owners Association and revie:•f your deed for any restrictions which may apply_
In consideration of the granting of this requested permit, I do hereby agree that 1 evill, in all respects, perform the u ork
in accordance vAth the approved plans, the Florida Building Codes and St_ Lude County Amendments.
The following building permit applications are ea-emptfrom undergoing a full concurrency review_ room additions,
accessory structures, swimming pools, fences, walls, 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 the first inspection_ If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
5
Signature of Owner/,essee/ Contractor as Agent for O'amer Signature of Contractor;/License Holder !
STATE OF FLORIDA STATE OF FLORIDA r
COUNTY OF COUNTY OF
I
Tlie forgoing instrument was acknowledged before me The forgoing instrument was ackno% wedged before ine
this �3 A� day of in 2;7 16( by this Z3 day of MaX4 by
i ll
(Name of person ackno ledging j (Name of person acknowledging)
(Signature of Notary Public- State of Fscri-ia ) (Signature of Notary Public- State of F loriri=-
Personally Known OR Produced Identification Personally Kncrvn � OR Produced Identification
Type of identification Produced Type of Identification Produced
�Jvp% GNril�.. ;r�
Commission No-' _ - _ 9A%13 8 nussion No_ `: t
MYC0MAUSS1%1# 05MN.
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RELrIElh1S FRONT ZONING F SUPERVISOR j PLANS ' VEGETATION SEA TURTLE MANGROVE j
COUNTER REVIEW REVIEW 3 REVIEW REVIEW REVIEW REVIEW I
DATE
COMPLE T E
INITIALS