HomeMy WebLinkAboutBUILDING APPLICATIONALLAPPUCABLE INFO MUST MECbMPLETED FOR APPUCATIONTO BE ACCEPTED -_
bate Permit Number: '
SCANNED
Builtlmg Permit Application ': BY
P/anning,pnd DevelapmentServlces $t` �UCI2 COUf14y
Buildif4.diidC6de'RegplaHonDNlslon''
230O Virginia Avenue, Fort PlerceFL'34982
Phone: (772) 4624553 Fix: (772) 462-1578 Corri.m@rCIBI R@SI6911tlal X
PER MIT,APPLICA7ION FOUR Renoyataon-_
Address:'o r:.
�,tegalDescription.;_fS�Glfl I�1 ' h'dDfVlln� YY1.��(fi11OHO`�:0( ����-2�3 RMqMJDL
3 Propert7 y.Tax 1D a i�v'O�vW DIIOD=fib0 Lat n o.
tSitePlamName m�_t-yz f = } Block No
—�
Pr6jkt Name irk
Setbacks: Front .. - Back Right Side -,- ' Left Side
17.
1C�S7� cS I"�otVtr Is1+.o�J✓f - 't'J�°/%'b� f/4m 'r�. -G[cC!//�Pl`' 0M1/wcyl%�G.
Additional work o be orme under s perm -Checka app y:-
❑H C GasTank ❑Gas Piping* Shutters,❑Windows/Doors
a ?. Elednc L"J Piumtiing Y oSprinklers Generator El
Roof �� Roof pitch
:'Total Sq Ft of Construction 5 Ft of First Floor
:Cost of Construction; $ y dap-Utilities:.Sewer �5eptic : Building Height,
;. - ,.: -.� -
Name ; �{ "., r , ame: Justin C.,Th ery.
Address'. 5,GCf-A F. I JJOV7, Company: IslandI<itchepandBath'oftheTreasureCoast
-
,Address. 10875 S Ocean Dnve
21p Code: Farrx,, £Ity Jensen Beach State FL
Phone No.?J U�i� Zip Code".34957 Fax:
E MaiCl'=:Phone No.'772 237J348
Fill in fee slmple Tltle Holder on next page (If different &Mail Jthlerylkb@gmaii.com
ti from tfie C+Minerlisted above) ;; aState or CoOnty License:- CB C1269308
Ifvalue of construgelon is $2500 or more, aRECORDED Notice of Cojnmencement is required.
a.
DESIGNER ENGINEER h x :'NotAppiicable
INORTGAGE'GOMPANV. ,x Not Applicable '
Name :
A"ddres's .
,Address ,
_City, State -_..
City ,. - 'State
Zip Phone
Zi
Zip Phone
�.
� �x
,FEESIMPLETITLE;HOLDER:"s x `Not'Applicable
BONDING:COMPANY ' x_Not:Applicable ,
Nia, n,e:
Name.;
Address:: . -
Address,'
,:
City
City` .
Zip Phone:` '
Zip: - '' Phone:
I certify that no work o'� insfallatlon has commenced priorto the issuance of a per
St Lude`Coun7ry make3 no representation -that is grantinga;ji rmii WIll.authorize the permitfiolder'to'build the subject structure
which Is iri co, lctwith
I any applicable Homeowners Association rules -,bylaws pr and covenants that 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 pemiit ,l`do hereby agree that I will, in all respects, perform the work
rin aaordance with the approved"plans, the Florida 8uildingCodes and'5t Little County Amendments
The following building permit applications are exempt fromundergoing ii full concurreniy`review room=addlbons, �,
accessory structu swimming pools fences, walls, signs, icreen rooms and accessory, uses toanother non residential use
WARNING TO OWNER Yourr{aeluie to Record a Notlte of Commencement may result in your-paying-twice{or
improvements toy' our property A Notice of Commencement mustlie recorded and pasted on the jobsite
beool etfie,first inspection I{ you intend to obtain financing, consult�'With lender or an;atitorney before
-commencin woik:oe.eec&di'ns�ourNotice"of�Cornirieoeement�' -
r .'
A, .�
s
SI ature:ofOwner/Lessee/Contra_ entfor Owner
„igga.. a Cori ctgr.UcenseHolder� �.
,STATIEVIFTLORIDA'
SFATEAF FLORIDA r ,
C�UNTYOF.�I \ICi2J'`�
COUNTYOF
'
The forgoing ins s cknowledged before me
t i_J2Ldayof A JKIiy
The forgoing instr m nt w a knowledge before me
this,1Zdayof��� 20 by
"2 nc"Thlery
(Nameo.p on,acknowIe grog sp a-
:(Name of personacknowletlging)
(S at(I: fNot . ublic te&Florida;),
(SI9dafUreof`NofaN1PdbII&State
i Personally Known _LL OR'P.rodueed Identification
Personally Known x. OR Produced fdentification
Type of Idehnfiwbon Produced= :
Type of Identification Produced
-.
civu
CommissionNo Q;M (Sea�ICHAELRRM1Z
m :'e, MICHAELRAAZ
Commission No. * MKBE1t11�SI0NIFF904140 `,
COMMISSION I FF 804140
EXPIRES: July 28, 2018
*;My
-
- • 0,2018
�+�5 +0� IondeO TAn�BUE N
�"� ^`�'y �9oM19+fTMNIrNhMpM,fYAenxei - -
Revised071.1512014,
REVIEWS—
- FRONT *'
ZONING LL .
SUPERVISOR;
'P,IANS
VEGETATION
SEA;TURTLE
MANGROVE,,L
4CObNTER,
REVIEW . J
REVIEW
`REVIEW
`:REVIEW.;' " :
REVIEW
REVIEW
,!DATE
COMPLETE
:INITIALS
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