HomeMy WebLinkAboutBuilding Permit ApplicaitonALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: cp' .S-l9 Permit Number:
s
auiliaing rerm>il Application
Planning and Development Ser;,ices
Building and Code Regulation Division
2300 Wrgirria Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PEKMI I APPLICA I IUN FUR: To Select from dropbox, click arrow at the end of line
PRUPUSED IMPRUVEMEN I LUCA I IUN:
Address: L7"
Legal Description;:
Property Tax ID #: SAD C1,23 Oo0 / Lot No.
Site Plan Name: Block No.
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
UE I AILEU L)LSCKIP I IUN OF WC)RK:
CONSTRUCTION INFORMATION:
Add€`fi a work to b-e effiormed -unoO
er this permit —�eck� apply
HVAC � Gas Tank ❑Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers El Generator ! Roof Roof pitch
Tota Sq. Ft of Construction:: Sq. Ft. of First Floor.
Cost of Construction: $ 7 (� Utilities: 0 Sewer Dseptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Narne T a p /, /'a/y�L
Address: d60 bit 4./}'B
City: "6it t Sf -State:G
Zip Code: 3 Zf L Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: CU(LITt '�' 'S-Aruyv,con
i
Company: cl r,T& nt A r- Li S c'i`i s (n: r:-
Address: IIt%I5 -S etc,-,e L 'reerk �D
City: Pe r T ,St , L u c a State:
Zip Code: +q5:2.- Fax: Y`r�• J �5-1 5 �a
Phone No. `7'1 a 3.3 s - 3.2 3 a-
E-iv1al: Cu ;tc-Ir E; 4� hc,( Cbioti
State or County License:. �� CC' (F l
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEM EN I AL CONS I RUC: I ION '-LIEN LAW I NFURIVIA I IUN:
DESIGNER/ENGINEER. Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
—
Name:
Address:
j
address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: !
Address:
Address:
City:
Ch
Zip: Phone:
Li p: Phone:
f certify that nowork or installation :gas commenced prior to the issuance of a permit
St_ Lucie County makes no representation that is granting a permitE_ill authorize the permit holder to build the subject structure
v:hich is in conflict kvith any applicable Rome Owners Assocratifln rules, b1_ lar;s orano covenants that may restrict or prohibit such
structure_ Please consult _firth your Hone Owners Association and re ie_v your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, 1 do hereby agree that I will, in all respects, perform tie e.,_erk
in accordance i!.ith the approved plans, the Florida Building Codes and St_ Lucie County Amendments.
The follo-wing building permit applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, s416mming pools, fences, �sfa ls, signs, screen rooms and accesson, uses to another nor -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.
Signature of O,,-�ierl�essee;ContraCor as Hgentfor O.a,ier 5io -ature of Contractor/License Holder
i
STATE OF FLORIDA r. STATE OF FLORIDA
COUNTY OF _ _ _ COUNTY OF -
I
The forgoing instrument was acknowledged before cone 1 The forgoing instrument ryas acknowledged before me
ibis s� day of lr 2Q / f by 1 this day of � , 20 by :
I i
I
i
(Name of person ackrimAedging) 1 !Name of person ackno��:tedging )
(Signature of Notify Public- State -of F GC�'Ia l (Si g-1latUre or No" Public -State of -Ion,.^=- 1
Personally Known OR Produced Identification i Personally Knmun OR ?roduced Identification
Type of ldentiiication Produced 1 Type of Identification Produced
CHRM
Commission No. _ ! - iq �l�f CHRISnNE etfymissrolf NO
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i EXPIRES: Apr? 4,
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REi. IRAIS
FRONT ZONING SUPERVISOR l PLANS ' VEGETA T1ON
SEA TURTLE
MANGROVE
COUNTER c REVIE`N r REVIEW ; RR lafV REVIEW
I RED/IEtM1'
RE1ilEVE'
DATE
COMPLE T E
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INITIALS
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