HomeMy WebLinkAboutBuilding Permit Application ALLAPPLIC4BLE INFO M UST BECOM 11=1 FORAPPI10Al1ON TO BEACCB7rM
Date: 5 It -a-a ! 15 Permit Number: I S a 5 -tS 335
RECEIV'-701 MAY WE
- Building Permit Application
Planning and Development SBrvices
Building and Code Fegulation Division
2300Virginia Avenue,Fort PlerceR-34982
Phone: (772)462-1553 Fax: (772)462-1578 COmmerdal Fbddential
PERAITAPPIKA1 11ON FOR To Select from dropbox, click arrow at the end of line
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Address: L `1
Legal Description: - _ e
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Property Tax I D#: _ Lot No.
Ste Ran Name: Block No.
Project Name: a-SPS4 C[ v
Setbacks Front Back: Fight Sde: Left Sde:
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Additional wor o bej performedunder is perms - appy:
❑HVAC LJ Gas Tank ❑GasRping _9iutters ❑Windows/Doors
❑Bectric ERRumbing ❑,04irinklers ❑Generator ❑ Fbof
Total ElI.R of Construction: R.of First Floor:
Cost of Construction:$ 1 b-6' Utilities Sower❑Septic Building Height:
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Name a�av-� � � p�vrC�s� `` Name: O C Lkk
Address:\?Al Q Xj,,� OY,Apk�nC\ �� Company: �_
City: n, Stater Address
Zip Gode`� Fax: aty'% Srk If"V Etate:�l.-
Phone No. - - Zip CodeaAgq Fax: �IrA `lLtll
E Mail: v Phone No.7)DQ - � , q aa
Fill in fee simple Title Holder on next page(if different E Mail:
from the Owner listed above) Elate or County License: C
If value of construction is$2500 or more,a FOOMED Notice of Commencement is required.
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�JPR..Em B�1TAL' srRJcTi0N_ u Ej4 LAW IN 0FWA110N :
DE IGNB11ENGINE2 Not Applicable MORTGAGEOOMPANY _Nlicable
Name: Name:
Address: Address:
City: ate: Qty: Etate:
Zip: Phone: Zip: Phone:
FEE9MPLETITLEHOLDI3R _Not Applicable BONDINGCOMPANY Not Applicable
Name: Name:
Address: Address:
CRY: city:
Zip: one: Zp: I Phone:
I certify that no work or installation hascommenced prior to the issuance of a permit.
3.LuceCount imakes 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 OwnersAssoaation rules,bylaws or and covenants that may restrict or prohibit such
structure.Pease consult with your Home OvvnersAssociation and review your deed for any restrictions. ich 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 Rorida Building Codes and 3.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
WARNINGTO OWNER Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commenoement 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 recordinci vour Notice of Oommenoeme
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_9gnature of Cjvner/ t .9gn re Contractor/License Hoider
STATE OF FLORI DA STATE OF FLORI D�
ODUNTYOF �C.rap, QOUNTYOF
The fo 'n instrument t was acknowled efore me The forgoing instrument was acknowledged b fore me
this dagy of 2 by this�day of 20 S by
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(Name of erson acknowledgi ) (Name of person acknowledging) o=° a@c
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(9gnature of Notary Publi Nate }� (9gnature of Notary Publi a of orida) o
Personally Known ORProdu Id Personally Known --,A ORPtoduced Identificatio
Type of Identification Produced Type of Identification Produced
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Commission No. ( � 'Z Commission No. _�E'Sg2gl (Sial) w "'
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Revised 07/15/2014
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FE/IEWS FRONT ZONING WPERASOR BANS VEGETATION TATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW FBABN REVIEW
DATE
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INITIALS