HomeMy WebLinkAboutBuilding Permit Application ,t PPLICABLE INFO MUST BE COMPLETED FOR APPLICATIC►N'TO BE ACCEPTED
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Date; +� t�' Permit Number:
RECEIVED MAY 2 8 2M
Building Permit Application
Planning and Development Services
Building and Code Regulation Divislon
2300 Virginia Avenue,Fart Pierce FL 34982+
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential `
PERMIT APPLICATION FOR
Address: �0� 1✓fY�
Legal Description:
Property Tax ID t, 912 -4f ' Lot No.
Site Pian Name: dock No.
Project Name: -- - -
Setbacks Front Back: Right Side: Left Side:
Additional work to be performed under this permit-check all that appy:
YMechanicai _Gas Tank ,^Gas Piping _Shutters Windows/[doors
_Electric _Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
Name a � , 1<, Y—X" _ Name: Cu+r,[5 Scumma-n S --
Address: ly� J �Q tQ�d�( d — Company: CtASa 'r Sk igm- A c:.
City: Al14 riP . State:M, Address: l l S G Tr 11 ap0 r ,n Dr•
Zip Code: 5�0?- Q Fax; City: �QyT �' LACI C State:
Phone No. Zip Code: NIZ Fax: T72 335' iq4
E-Mail: Phone No. 7733f5
Fill in fee simple Title Holder on next page t if different E-Mail: C,Q.Stls tr� s� 91
from the Owner listed above) State or County License: CA C 0130,q 10 • 5-14t.e. '
If value of construction 19250WOr more,a RECORDED Notice of Cammencentant is required.
7�"ri0
PDESIG"EREWINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name., Name:
Address: Address:
City: State: --- City. State:
Zip: Phone: ZIP. Phone:
FEE SIMPLE TITLE HOLDER: 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.
I certify 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 perrait holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your glome 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 respedts,perform the work
in accordance with the approved plans,the Florida Buildipg 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 faildre 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 our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/Ucense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S T L-U C t.–, COUNTY OF�. S T L,V(I e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day ofg 201_� by this_at day of go Llby
IJr fI!' 5Oinmon S-
(Name of person acknowledging) (Name of person acknowledging)
'rW Z
(Signature of Notary Public-Ste of Fiorida) (Signature of Notary Public-State ofol,6rida)
Personally Known !'rOR Produced identification Personally Known OR Produced Identification
Type of Identification Produced Y P go SH Type of Identification Produced
9 �y MY COMMISSION t FE d doff ft� a !
Commission No. S f . l) EXPIRES,April 4,2017 Commission No. IQNIEE
'',a daigedllw Budpdrdat�Y S y; !RE$:Ap18 4,201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.-1/2014
/ ,� 6600
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