HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR A€PUCATION TO SE AEEEP M
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Bate: l 7 ! I Permit Number-
-- tgi�eit Application
Planning an Services
Building andotde.R�gutan 7Jivisioh fl
2300 VirginioAsaenue,Fort Pi2rte FL 349
Phone:(772)462-1553 Fax:(772)462-W8 Commercial Residential
PERMIT APPUCATION FOR: To Select from dropbox, click arrow at the end of line
Address: S 7 ° Z (,fi n 4e-rC G A-CoeN �•J
Legal Description: LA IWO n
Property Tax ID# _ .I 50 1 " (0(.3 . O 3 fo S"� 470C) - 5'" Lot No.
Site"P1an Name: inI 4* s i O S e✓ "A S Block No. /SZ
Project Marne_
Setbacks Front Back: Right Side: Left Side:
-� on Wo to rmod under this a
��{Wp,C Gas Tank []Gas Qiping Shu#ers Windows/Boars
Electric Plumbing Sprintders �e fc lz�ator Road .Roof Bitch
Total Sq..Ft:of Construction: Sq.Ft_of 1=�Floor:
/ 51!3 s itiiises:}_�Ise�rer
Septdc Building-height -
Cost of Cons� �
itiGn .$ �1 _
- _ �_ '__=
Name S i os ea ATA s Nari Pe rA itl
=,Z=:t l� w a � �K.r�/ Cora .1 y es. l r e C ers� 1 c 4
Address: ?o - , 'Y. .
f Address- p1.0 3t�x78'1Q93'
-, State FL
rt T = state--
T1 `Code: 3 - fi - Fax _ City: -- - - te:
32878-1993 Fax:
phone No_ �too 332 _ { Z Coe�e:
1 Phone N0 X?Z
E-Mail: { coy
e T-Me HOkler On s�d.Page(��' £=Mail: � 97
Fill in fee sirtn� .
from the owner listed above) f stave.or county Licer-se: CCC l
=valueW or nprel.a ftECt� :No1 cT Czim t� required.
�DESIGNEtJENGIIVEER: Not Applirable A�RTfAGE COMPANY: Not A.pplicab}ey
Name ,-Y-f.�,. Dame:
Address:" - n° Address: I
City:. State: City: i State:
Zip:: Phone: Zip: i Phone:
FEE SIMPLE TITLE H®i:.i3ER: . : of Applicable 4 BONDING COMPANY: [Not Applicable
Name: Name:
Address: Address: G
City: f ' City:
Zip: Phone: i Zip: ! Phone:
s certify that no work or installation has commenced prior to the issuance of a permit.
St Lucie County makes no representation that is grantir*a Permit will awthorize the permit holder to build the subject structure
which is in conflicts th any applicable Home Owners Awn rules,bylaws orf'land covenants that may.restrict or prohibit such
structure.Please sth consult w your Home Owners Assoaation and renew your deea for any restrictions which may apply-
in consideration of the granting of this requested permit,i do hereby agree that(!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 f4um undergoing a full coricurrency review-room additions,
accessory structures,swimming pools,fences,walls,sugns,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER;Your failure to Record#Notice of Commencement maytesuft in your paying twice for
improvements to your property.A Notice of Commencer,ient musti'plbe r rd and on the jobsite
before the first inspection u intend to obtain financing,conhsu�W ten r or atto ey before
commencingwork or re rdin our Notice of Cornmenceanent. j!
� y
s
Signature of er/Lessee/Contractm t for Owher signature o tractor/license Holder
STATE OF RI®A SLATE O t�? IDA
CCaUI F Ct1U t?
The forgo ent was acknowledged before me The forgo! 'nstrurnent was acknowledged before me
this l___ ay a ns,=Lr 2(?,J_by thid��day�of / 2O -by
pew?cafam 1 1 Peter A Caiam Ili
(Name of person acknowledging) (Name of personacknowkedging)
r -
igna re • Diary Public-'Sta e of Florida Public State Florida)
Personally
X OR Produced Identification
Personally.K own. X OR Produced Identification y
Type of identification Type of Ide[;Itification Produced
�typ� af
Commission No. �� Karim Commission No. xa:arg e l teofl
r Kan M R -
; g: My cuff i=on FF 98*V
Revised U7/15l2U14 }
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REVIEWS FRONT ZONING SUPfRV1SOR PLANS i' VEGETATION SEAT11RT1E G7\J
'COUNTER REVIEW I,EViEW s REVIEW i I REVIEW REVIEW
REVIEW
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IiPLETE
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