HomeMy WebLinkAboutBuilding PermitALL APPI.ICABM INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ~12)J.I Permit Number: _______ _
COUN-i y ........_
fLOR(DA
Building Permit Application
/ Planning and Dellelopment Services
Bui/ding 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
Address: _.k«:1'.__~JAj'li},(l'[__!l~L¥-.. ~~JJ~~'----rb:::__.2_:t!:;?_!_ _______ _
Legal Description: ~4:w.u..i4.J..!.All>.L.l.~.ll.ll~!.I..L£~:..!:..ll=---------------.L...-
PropertyTaxlD#: _______________________ _ Lot No .. ___ _
Site Plan Name: _______________________ _ Block No. __ _
Project Name: _______________________________ _
Setbacks Front. ___ _
Gas Tank as Piping
D Plumbing Osprinklers
Shutters
□Generator
0 Windows/Doors
□Roof
Total Sq. Ft of Construction: ______ _
Cost of Construction:$ 52-0D. DO
~ of First Floor:
Utilities: LJSewer □Septic
Name,.:..u=~:...:....-""'"'-LL"-...._.LLLl-1-1=''1W_i_ ___ _
Address:._~L-.;""'-A4'L.>O""-->l¥"""j,----=-
City: ti)(,l-; Y!IYI State: Fi,.
Zip Code: 34951 Fax:~------
Phone No. 11 l,-Y:]$ -O(,JJ..l
E-Mail:. ______________ _
Fill in fee slmple T"ltle Holder on next page ( if different
from the OWner listed above)
Company:
Address:5(0 A
City: (orb Pr'e,rce., State: P'l-
Zip Code: ·3 lf:9 5 l Fax:71.:L-t.ll,f-3731
Phone No. :M;J.-% { -414-I
E-Mail:~leae e 'f baa. en('(\
State ore: nty Licen~ CAc,lil'SI~ (p
If value of construction is $2500 or more, a RECORDED N-of COmmena!ment is required.
SUPPI..EMENTAL CONSTRUCTIONUEN I.AW INFORMATION:
Not MORTGAGE COMPANY: _Not Applkable
Name: Name: Address_: _______________ Address'--=---------------
City: ____ -::,:-------State:_. _ City: ____ --,-______ __,State:
Zip: _____ Phone'----------Zip: ____ Phone:'-----------
FEE SIMPLE Till£ HOLDER: ~ Not Applicable BONDING COMPANY: _Not Applicable
Name: Address'--: ______________ _ Name:. ________________ _
Address: _______________ _
City:~----=----------Zip: _____ Phone:. _________ _
City: _________________ _
Zip: _____ Phone:'------------
OWNER/ CONTRACl'ORAFRDVIT: Application ;,, hereby madetn oblain a pennit tn do the work and installation as indicated.
I certtfytbatoo woric°' F-sl M ,-on-bas.mrmhelar:ed tJl'iortotbeissuanc:e of a permit.
• St. lut:ie County makes IIO li!jll 2 1talio,t that i,, jjialtlillg ii~ will aulhori2e the uennit holder ID buld the~ structure
which is in c:onllk:twitllarrt !IPPlitable Home owner.. Asw+ iatkN' ,.ilei, bylaws qr af_lll aM!ltallts lbat ma,: restrict or prphibit such
slruClure. Please amsult wilb your Home 0wnels Association and review your deed for any resbictious ..midt may apply.
In considerallon of the gira,ding of this requested permit. I do hereby agree that I will, in al respects. perform the wort
in aa:ordan<:e with the appil.NB1 ,.tins, the Rorida lloilding Codes and St. LucieCotalty Aneillmertts.
The followin& bllildillg permit applications are e,rempt from undelgoing a full COl10lffBICY rev-= room additions,
accessory strucbm!s, switmning jlOllls. fences, walls,signs, screen rooms an,! ,. + en r uses tn anotbB non-residential use
WARNINGTOOWNER:Yrm-failuretoRemnlaNotir:eGfCou•11EhC115iihillt,"111Yresultin,--payiagtwla!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
commem:1n work or recordi Notice of COmmencement.
~~~~
STATEOFFLORIDA <L I ,.~i
COUNTY OF <....Jf • vJAUl-
The forgoing instrument was aclmowledged before me
t11is~c1ayof Mo.cm .202-1 bv
~ f. &;1i'e.-
Name of~ ement
Personally KnuMl__j/_ OR Produa,d ldeiltificaliun __
Type of ldentificaliun
Produced'-----------
-~tL,L-
Signature of Contr.lctor/1..ia!nse Holder
STATE OF FLORIDA COUNTY OF ___________ _
The fu1goi11g Instrument was acknowledged before me
trus ~dav of t1onb • 20 ..i, by
~~~~ Personally KmMn _,_ __ OR Produced tdeutilitation __ _
Type of ldentilicatiim
Produced. _______ _
~&
of Florida)
REVIEWS FRONT ZONING SUPERVISOR . PlANS VE<iETATION ROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
COUNTER REVIEW REVIEW REVIEW REVIEW