HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLAPPI.1G4Bl INFO MUSTBEOOMR_ET® FORAPPUCAMO N TO BEAOCB�T® �-�(
Date: -� SCANNED Permit Number: (�5 `�3 �
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uc Be ounty,
BUilding Plermit Application
Ranning and Development 8xvioes
Building and (ode, Regulation Division
2300Virginia Avenue, Fort ReroeR-34982
Phone: (772) 462-1553 Fa)c (772) 462-1578 Commercial %sidential
-:
,111111
Address:
Legal Descript
:UCAMO N FOR To Select from dropbox, click arrow at the end of line
IMPRIOVB\ fB T LOGA►11ON:
d d A-1 u // G- Ae
Property Tax lb#' l,-?- 7 v 8 b / ' eo Ya - &to - �' Lot No.
Ste Ran Nam: Block No.
Project Name:l
Satbadks Front Back: Fight Sde: Left Sde:
DUAIUD DE9CIPTIO OF WORK
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Total Stl. P of Cbnstruction:
Cost of O mst�uction: $ S -J' 0
ing LJ Siutters
rrs 0 Generator
l,%wer
of First Floor:_
Utilities 033ptic
EIVlfindows/Doors
Roof
Building Height:
'CM, B:W L
COMP_ ACTOR
Name ray 4hg e- Cf- i So Oc e
Name:
os
Address Q9g6D A414//1"fAM, C,`If-
Company:
'eits
P l'4�s31
City: P J j L gate: Fe-
Address:
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Zip Code: Y r6 Fax
city:'
gate:
Phone No. 7 '702 3 � �! - 6 eZ
Zp Code:
"t rt �H2
Fax 3 3 ca
E-M ai I :
Phone No.
-3 3 .-7
46 r31,4-
77
Fill in feesi pleTitle Holder on next page (if different
E-Mail:
4Sp,--.-, e-e-f Q
from the ner listed above)
gate or County License:
CC �L / ?'��i / �►.3
If value of coo'struction is$2500 or more, a RBJQRD® Notice of Commencement is required.
3 PPLEM BVTAL OONSTRUC110N U EN LAW I NFQFNATI ON: ;
DEJGNB�! ENGINEER
Name:
Address.
city:
Zlp:
_ Not Applicable
MORTGAGEOOM PANY _ Not Applicable
Name:
!
Address:
State:
Phone:
City: State:
Zp: Phone:
FEES MPLETITLEHOLDER
Name:
Address.
City:
Z1p:
Not Applicable
BONDING COMPANY Not Applicable
Name:
Address:
aty:
I
Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
a. Luce Count makes no representation that is granting apermit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenantsthat may restrict or prohibit such
structure. Please consult with your Home OvvnersAssociation and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agreethat I will, in all respects, perform thework
in accordancewith the approved plans, the Florida Building Codesand a. Lucie County Amendments.
Thefollowing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory struc'ures, swimming pools, fences, walls, signs, screen roomsand accessory usesto another non-residential use
WARNING TO OWNER Your failure to Record a Notice of Commencement may result in your paying twice for
im rovementsto your property. A Notice of Commencement must be recorded and posted on the jobslte
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencinalwork or recordma vour Notice of Commencement.
re of Ov'uner/ Agent/
STATE OF FLOM DA
COUNTY OF I '
The for ing iristrum t was acknowledged before me
this of 20 14 by
'Name of person acknowledging)
re of NotfrA mate of Florida)
Personally Known
Type of Identification
Bonded Thru
Commission
Revised 07/I15/2014
STATE OF F-OR DA
COUNTY OF rc�
The f r ing instru ent was acknowledged before me
this ay of 20_1A by
(Name of person acknowledging)
(Signature of
Personally Known
Type of Identificat
1 Undetwrkerg I� I Commission No.
of
silo
ly