HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE CQ`_-___ =ETED FOR APPLICATION TO BE ACCEPTL'.:)
Date: 5 j 12J Permit Number: � ' 61 9( 3
RFCFrV�o
Building Permit Application per
Planning and Development Services S Stu ?�
Build
and
ivision
2300,Vi�g niaCode Avenue9Fort Pieulation rce FL 34982 t �4cie� 4 ent
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
x�EY�wIrl ( ,y',5
- >uir+;Yab,. K d,YL `3Ya � �� WIN
Address:
. ,SD � .C> �S(,AS)I Adr12,a,L �1 P,62C.;, rL3ilSS�/
Property Tax[D#: Lot No.
Site Plan Name: ��'/�� - 2 13- 12 `�,t�,e1 Block No.
Project Name: St- W
Pro
��11' :s '�.a�'"-:-•. g '. `r:.2
APO+��a .-� 7o cr►-c.oc ft-1-0-0 ase SG, `f' l_JJ.J,9 GO c i"-C4-ems NA 1)
W16 2Z 04 4- /Zr ISA A 4J_J- IWAM
,G f
a��,.�' sem.✓� - � �e- � dta a ars�v.*
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof /r •Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ a,�t7�• Utilities: —Sewer —Septic Building Height:
,, >? �` _ �"d1P,::.
Name Name:_ 4-
Address: jp&gpo SLgsH j>.-i 2 j 0,c,. lCompany:
City: F f A,..M L tC state`--F� '-Address:
Zip Code: 37 s.T I Fax: City: State:
Phone No. 9SJ-1- f(3
Zip Code: Fax:
E-Mail: KS tnQ K t -za `tIA�00 �,3 -,
Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is$2506 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.
"*,*s,� "b
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _XNot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: 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.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with anyapplicable Home Owners Association rules, bylaws or and covenants that 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,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 THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature ner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE LORIDA STATE OF FLORIDA
COUNTYF � � COUNTY OF
The forgoinstrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 11yelle 20y this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification �� Personally Known OR Produced Identification
Type of Identification,� Type of Identification
Produced J li Produced
Signature of Notary Pub State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal Commission No. (Seal)
44
C'Zn _
.c3GM
REVIEWS FRONT ZONING a D� R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ®�
RECEIVED ® D o c
DATE
COMPLETED 9
re—v. �, o