HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB_ LE IJdFO ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � - Permit Number:
tI L-L-! C-12t
Building Permit Application
g pp •Pfanning
and DevelopntServicesBuilding
J��"
and Code Regrlon Division Commercial Residential2300
Virginia Avenue,rr Pierce FL 34982
Phone: (772) 462-15 Fax: (772) 462-1578 CBDG Funding
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PERMITAPPLICAiiION FOR: 11 (Ka Ytann{ Q t �e
R6p,Cf5�bFf 1_l1V1fMW 40I °1<',a,Y a :
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Address: 1J W (.tax A y -ect"] Q�M C
Property Tax ID p: qY3L - &d f - 000-? - 600 5-Lot No.
Site Plan Name: l 34 3 fJ LLi W m r, nt y �f(e j r'a. Block No.
Project Name:y'Aey(e- jee-r&cU p
JE
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.1%K 6 &a I I N ¢
kAJ 106 -,- 40-1 d- 4 tMA-
1 n Sffrdl AJcW
Tr?e W1 VaP k' [+ /(" 0 •T: 1t 4a.)..
New Electrical Meter Second Electrical Meter (Affidavit required)
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Additional work to belperformed under this permit- check all that apply:
_Mechanical i'Gas Tank _Gas Piping _Shutters _Windoyrs/Doors _Pond
Electric _Plumbing _Sprinklers Ij i- _Generator _Roof Pitch
Total Sq. Ft of Construction: �O 3Sq. Ft. of First Floor:
Cost of construction: i Utilities: Sewer _Septic Building Height
Name _►-inIk4-1A!k%vZanne OiSggbe
Name:'1>J de- Larc�-
CAmpapy TOkq{ lewli tfaa SvakartS'TV1C M by(
Address: 13 of 3 /4Jw (Talc rny/ ❑C T/a I I
City: � m Cr ! State:r_L--
AFdWadraWeis--FAL40 5z 4f )gtmley �•
City: SkumAm State: R.
Zip Code: 3`%�lgV� Fax:
Phone No. -F37l:'•g?97 E-
Zip Code: '34q I Fax: T-7X7'7 •9033
mail: k61004L rw Mae.• CSarvt
Phone No 771- %7 i ff03J
Fill in fee situp a Titl H{flder on nazi page (if different
E-Mall G,iw.t IQo&
State or County License ?!'-.r- C. / 33 33Yf—
from the Owner listed d above)
if value of eonserueuod is 2500 or more, a RECORDED Notice of Commencement is required. 111
If value of HAVC Is S7,SOo pr more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINE
Name:
Address:
City:
Zip: P
_ Not Applicable &�
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
State:_
ne
City:
Zip:
State:_
Phon
FEE SIMPLE TITLE
Name: _
Address:
City:
Zip: P
L ER t plicable
BONDING CO IP NY Not Applicable
Name
Address:
City: _.._
Zip: Phone:
_.
one:
OWNER/ CONTRACT RAFFII
I certify that no work or in tailation
St. Lucie County makes no represer
which conflh with any a pllcable
structure. Please consult ith your
)VIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
has commenced prior to the Issuance of a permit.
In consideration of the gra iting of this requested permit,) do hereby agree that I will, in all respects, perform the work
In accordance with the apt roved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building per nit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swin ming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNE : Your failure to Record a Notice of Commencement may result In paying twice for
improvements to four prope Notice-efCommencement must be recorded in the public records of St.
Lucie County and 1 losted o e' bsife before the first inspection. If you intend to obtain financing, consult
with lender or an tt_cL ore commencine work or recordinp vour Notice of Commencem m
e
or- Owner Builder as applicable
Signature of or
STATE OF FLORID
COUNTYOF
dWTM
Swom To (or affirmed) at
d subscribed before me of —L-5hysiwl Presence or _ Online Notarization
this day of inn
203Yby
Name of person making
tatement.
Personally Known ✓'tl
OR Produced Identification
pe of I tifica Pr
_
h
(Signature of Notary uli
Commission No.Q6i-dEs3rdf
t to of *cilia)
'a'A ti'. THERESAJAFF]Florida
(Seal) f'• \� Nowry Public State o: 4t CommnsmnirGGpr�oMy
CommsslonP sA2Bondad
through National No
REVIEWS
FRO N
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
DATE
RECEIVED
iI
DATE
COMPLETED
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