HomeMy WebLinkAboutBuilding Permit ApplicationAl{ APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit NLir:De'
Building Permit Application
erd Deveioprner: 51rVices
3;;rding cnd Code Reguiatior. Division
230C ✓irginio Avenue, rorr Pierce FL 34-981 ✓
COr?�m�rCial esidentiai
Phone: ?72j452-1553 Fax: (772) A52-157g
I PcRM! T APPLICATION FOR:
._address: :'2 (J
:ecai Description:
propery Tax ID 4
S to Dian Name: _
pro ,eR NaMe_.�
Sr,Gacks =rant.
W009 r,UMIORNWIM
Right Side: _ Left Side:
O
Lot No. —
Btock No.
�
i
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i
do�trona wo to
_o pe rme un .Pr t is permit — c ec a t
at app y:
WindCWs/DOorS
5hv+tprs
l
"ale:f a^iCai
y Gas 'rank Gas Piping
_
Sprinki erS
_. Generatt?r
_. Roo-
Wert-��
.r ?i�•, .�: ._
SCj. `t.
o! C:rst -100r:
;a' sq. `t ^,' CnsTruc-ior
!
Building Heighu
siruCticn:
l
i ftilitie5: _Sewer
Stoola
-
_Septic
!, Nam- .. 5rnn��
dig. any':-
4ate: Address: _i t05
State: • ,
C. `
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r� �/�� -7ip Code: 3G93' : ax: �ZI- %i7 '1Z3
�^ �p No. - I
�l _ -Ma' Phone No. 77�
ii
gill in fee simple Title Holder on nextif different
page (• �• ,
the Owner listed above) Stale or County License.
I,
i; of Commencement is required.
if value or construction is 2500 or more, a RECORDED Notice
Yµ'
DESIGNER/ENGINEER: Not Applicable ! MORTGAGE COMPANY: _ Not Qpp!icable
Name Name:
Address: 1 Address:
Ct'v: State: City: _ State:
Zip: Phone: , Zip: Phone:
FEE SiMPLf TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name: _
Address. i Address'.
�.
zip: _- � Phone: Zip: Phc to
tha: no Work or Installation `has cor•.':menced prior to The !SSua'a-e OT c^ petm.L.
5:. _UC!c COUn*y ?IcnICES n0 reprC5Cn'.8iion that i5 granting a permit wili authorise the permrT holder to build the subject structure.
which is !n confiiC with any applicable Home Owners Association rules, bylaws or anc. covenants that may rest. IC! or prohibiT ouch
strucrure. Please consul, with your Home Owners ASSOCiaTion and. review you. deed for any restrictions which may apply.
•n consiue'atior of the granting O" :his regc.ested permit, i do hereby agree that ! wil!, in al! resp?c.s. p e, Torn the pork
rr. accordance:with the approved pians. the Ficrida Building Codes and St.:.ucie County Arnendmants.
-!,e foliowing building aermit appiicatlons are exempt from undergoing a Euii concurrency review: roorn additions,.
accessory S%.Ic-lures, swimming goofs, fences: walls, signs. screen roorns and accessory, uses tc another non-residential use
WARNING fO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
!rnproverne tts to your property. A Notice oY Commencement must be recorded and posted on the;obsite
before the first inspection. !f you intend to obtain financing, consult with ler.der or ar, a«orney before
comr,'tencrnE work or record,'ne vows Notice O"i Cemrnercemer t.
_'j-�natore j) -Owner,- Lesse- Agp
STATE OF FLOR4
COUNTY OF K-%_J-A baAd-
ins'r' `,' was 3cknov:ledge" ore 'ne
i 91gn� 2M-rE Ov Con CrBc-4cri:rC .s? "+OIOe
STATE OF Fir
COUNTY OF C�dLJ
! vha o:-ge;ng inscru v: ae xkno�+!edge
this day of 20 / % by
M'
"�•� ••- o- (Name
X;,
<<.ure o ota ubli, State
person acknowledging
re Cr
cf
! °2'5onaf!v Knowv OR PrQCuced
! denTi !Cat;or•
' eersora,; Nnown _� v vn—VVJI_J rver.an�&'r cn
y
t
1 -•,.Og p"'do^tif!ce t'Or'oOUC£C
f Type of !dentifiCaiion ?-oduCeC!
yp
;Seal)
or.:No.
nn
Cn i cS h
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Notary Public State of Florida
Notary Public State of Florid
oil
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n—!se ii i pr 014
My Commission GG 152970
�w Expites t0/18/2021
M CommissionGG 52970
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`�� Expires 10/18/2021
3�Vt VeS FRONT ON!NL SUPERViSCR
PLANS
VEGETATION SSA TURTLE 'V!ANGROV'E
COUNTER REVIEW ! REVIEW i
REVIEW
REVIEW REVIEW REVIEW
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