HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONj \
ALLAPKICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BEACC4 P i®®
Date:
Permit Number.
SCANNED
• ERECEIVEI
St. LUCIeCourRy
®ui� *g Permit Applicato®n9PlanningandoevelopmentSffuk esBuilding and CodeRedlaVonply� mitting
23W V'rg nlaAvenue, Fortpleme FL 30&2
Phone: (M) 462-1553 Fax; rin) 462_YS78 Commercial
Residential ��
PERMITAPPUCATION FOR: To Select from dro
Ix, click arrow at ttro end of Dine b PROPOSED IMPRn(fFiini:nrr.: &•A 11...,
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ProperwTaxiD4f:�Y� ��03_ib35�12� 9
Site Plan Name: -1� Lot No.
e Block so
.ject-ftm.
Setbacks FPom O Right Sied
_ L _ Back:10 gLeft Side: 10
EXTL-W15 £XtST;,Ji t4IG G/ts APPRoX. 5 -A NELJ Ge�aC
Car lt44te ' FniZ rP44 ,
!_ WA ✓Gas Tank I ✓
Gas Piping _Shutters Windows/Doors
_Electric _ Plumbing _ Sprinklers _ Generator
_ Roof ® Roof pitch
Total Sq. Ft of construction:
Sq. Ft of First Floor.
Cost of Construction: $ R 3G • 00 Utilities.- _Sewer _Se
ptic Building Heighk
• • e nH Name: A#4
Address: GS12 tJ $1,1�.
�� P Company: 7Y +Qa State: Fl Address: W
Tip Ca —�y�qO Fax wY
Phone No. 3 03 r. P�� C'�' State: F[ .
E-iiAail-rY Tip Code. Fax
�seLNy AIM Ca vtL_ .�� o/� Phan No. Ma.
Rif In fee simple Tidg Holder on nettt pW(H &Went
from the Owner listed above)
State or County license: —.559 �1 err r
ffvalaee ofm'sh eW is $2500 orfimm, a REt DRDED Notice of C%----_—_ .: Comenencementisrequhed..
r
DESIGNER/ENGINEER- _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name _
Address:
Address:
City: • State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLETITLEFIOLDER: _Not Applicable.
Name:
BON DING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City -,-
Zip- Phone:
Zip: Phone:
UMIMEI(/ COMTRACTOR AFFIDVIT: Application is hereby made to obtain at 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
no
ermit holder to build the subject structure
covenants that may restrict or prohibit such
u 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 exemptfrom 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 on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement -
STATE OF FLORI , STATE OF FLORIDA
COUNTYOF c , CS 1CLe COUNTY OF cS�. ��Cle
Theforgoing mstrumeptwas acknowledge efore me The forgoing instrunlentwas acknowledge before me
this day of _ 20�My this'�Qday of �Y li(1 20� by
Danvii
(Name of perso acknowledging) (Name of person ac owledging )
-� (Signature of Noilary Public- State of Florida)
Personally Known _� OR Produced Identification
Type ofIdentification Produced, - —
Commission
My
(Signature of Notary Pubic State of Florida )
Personally Known X_ OR Produced Identification
f=of Identification Produced
REVIEWS 1 FRONT PLANS
COUNTER I REVIEW I SUPERVISOR ZONING REVIEW I REVIEW
mission N GG 19�82
Commission Ex es
VEGETATION I SEATURTLE
REVIEW- REVIEW REVIEW