HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAlLAICABLE INFO Ml1Sf BE
Date: 1 S
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FORAPPLWATIONTO BE -ACCEPTED
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PerI��a�031� mFt Number,
Building Permit Application
Plonning and f)eve%pmenrSeMcm
Building and Code Reiman Dimbion
2300 ViOWaAwnue, Fort plerce a 3082-
-Phone: (M) 462-1SS3 Fax: (772)-462-1578-
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Commercial Residential 1
PERMITAPPUCATION FOR: To Select from dropbox, click
Address:
Legal De;
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Site Plan Name: ��wrw/£J7 E Bye t IJ kL . =-n
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Lot No,
Block No.
Setbacks Fiont—LO— Bade f 0 , Right Side: '% n �_ Le} Side: I O
�DETAIIED;D8CRIPTION OFVIIORK:,
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%M/AC-eGasTankEN" +as Piping _Shutters
Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator
• _Roof Roof pitch
Total SQ. Ft of Construction: Sq. Ft of First Floor,
Cost of Construction: $ _�(Xj . Utilities: _ Sewer Se
— ptic Building Height;
Addr e I G R
City, TO
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Phone (do.�ob
E-Maih_
FlB In fee SkWe Title Holder on re nt page (if different
from the Ownef listed above)
Name:.,L
Company:
may: M-A C•,I
Zip Code: ZY92a Fax
Phone No. L72-GezQ
E-Mail:7AY�1fop!
State or County Licenses O e;C4 V ; v5.
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY- Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE IfOLDER: _ Not Applicable.
BONDING COMPANY: _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.
tcertify 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 any applicable Home Owners Association rules, bylaws or and that
covenants 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 pioperty. 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
commencing work or recording our Notice of Commencement.
a'rM-on facttrorlrticens 2r
rrer! else
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF cyi I G>A
COUNTY OF '� . LllCi�
The foIf�Ding instrument was acknowledge before me
this day Fe',L7VL1 IA)
The forgoing instrume{�t was acknowledged before me
a of 20]g by
this'A day of 20 by
i
Lpnu� a �� 1t ran►
(' ➢a�
(Name of person nowiedging)
(Name of persa cknowledgmg) -
(Signature of Notary bllc-State of Florida)
(Signature of Notary public -.State of Florida)
Personally Known Y OR Produced Identification
Personally Known -k—OR Produced Identification
Type of Identification Produced
Type of Identification Produced
lic
2
BRITTANY R
Commission No� ' l Srara of Floritla-N
Commission#G
D"U'i;. ,a oa,,, RITTANY REDD
&4mrnission No. 'f µ W, . of Florida -Notary
190282 =• •= Commission#GG190
My Commissio
Expires %qh.?;�` My Commission Expi
REVIEWS
FRONT
ZONING
PLANS
VEGETATION
SUPERVISOR
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW .
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 7/203-4