HomeMy WebLinkAboutBuilding Permit Application AlLAP4�liCABLEiNFOMUBt'BEC3'�MPGI�� Tt} ACS
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et5 `�" Permit Number.
Date:
plication
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Planning and Development Services
Building and Code ftulation Division
PiC
2300 Virginia Avenue,Fort Rerce R 34982 rte_
Phone:(772)4621553 Fax (772)4621678 03mmerdal 4�idential
PffWITAPPLiCAT(ON FOR To Select from dropbox, cii k arrow at the end of line
�PKPOM IMPROVEMENTLOCA?TON:
Legal Desa•iption:
RropertyTax lD#. .333 J/ e o - 4 a ata - 60o • 3 Lot No._ �7
Ste Ran Name: Block No.
Roje t Name.
Ekitbades Front Back. Right 9de: tuft Sde:
DE POD DE9M.PnON OF WOR<
7"
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OONSTRIJG C}N 1NFOWAMON:
ton wor o e orm u er ispermi - JR.
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Ges Tank []GasRpingters '' WndowslDoors
OBectric EgRumbin6 []�rinkiersrator 0 Fbof
Total�.F t of(bristruction: t Floor.r+Cost of(bnstruction:$ 6sO- OV UtilQSeptic Building Height:
OWNER IF'q 00 Cl'Of�
Name J='1 r+/�'e GO S Name o �.l 7-"Lt
Address oda 0 Company. p.c 1 L 8•—� - f c��
C] 19 x C.. Sate: F4. Address /`�`� .Sty �'
Zip Code: 3 Y-136 Fax aty:
Phone No, 7!4K t ' r `t cf f dip Code 3 Y,41.� Fax 33-s �cPa
E-Mail: Phone No. 7 7a2 33 -7 3 ra l
Rill in fee simple Title Holder on next page(if different E-Mail: f +e-+•`s �r 6, s +tet Q 7-
from the Owner listed above) estate or�unty f�censia: C /f06-1�t t D 3
if value of construction is$2500 or more,a R330FOM Notice of cbmmencem nt isrequired-
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.aimim ENTAL OONSTRJG oN L EM LAW INFoFwA-n
DE'SIGNERENGINEER Not Applicable MORTGAGE-COMPANY: Not Applicable
Name: Name:
Address. Address:
City: gate: City. Sate:
Zip: Phone: Zip: Phone:
FEE SMPLETITLEHOLDER Not Applicable BONDIN OOM1'ANY: _Not Applicable
Name: Name:
Address. Address
City: Qty
Zip: Phone: Zip: Fhone:
I certify that nowork or installation hascommenced priorto the issuance of a permit.
3.Lucie(buntY makes no representation that is granting apermit will authori the permit holder to build thesubjecf structure
which is in conflict with any applic ft Home OwnersAssocration rules.bylaws)rand covenants that may restrict or prohibit such
structure.Rease consult with your me OwnersAssoaation and review your i leed'For any restnctionswNch may apply.
In consideration of thegranting of this requested permit,I do hereby agreeth I will,in all respects,perform the work
in accordancewith the approved plans,the Florida Building Codes and g.Lucie County Amendments
The following building permit applications are exempt from undergoing afulI ccncurrency review:room addit ions,
accessorystructures•swimmingpools fenoes,walls,signs,screen roomsand ac nssory usesto another non-residential use
WARNiINGTOOWNER Your failuretoRecord aNotice of(bmmen entmay result inyour paying Woe for
improvementsto your property.A Notice of Commencement mus be recorded and posted on the jobsite
before the first inspection.If you intend to obtain financing,consu t with lender or an attorney before
commencinq work or recording our Notice of Commencement.
C-Tgnature Owner/Agent/Lessee ureof n Tactor/L+ornseHolde
SFATEOFRORQ SFATEOFOWDA
OOUNTYOF C.�� OOUNTY F 5`, ,L c—Zo�
The forgoing instrume t was acknowledged Wore me The forgoing instrument was acknowledged before me
this-4dayof 20 l3 by
this d of 0. 20by
12-10A A 14416V
S /
( ame of person owl ging) / (Name of per son nowledong)
(SgnatureofNotary JE F.PIQUION (Sgnatureoi Notary Rblio-EState Florida)
I�rwrialiy Known dk F MQ Florida Personally own ✓ ORPr ification
I Typeof Identification '''Vw" 47 Type of
IMunk" �
Ii °�: %ctaty Public.State o1 Fbrida g y
Commission No. (Seal) Gbmmi FF 4772(SI
� 2017
My comm.expires AVr•27, ��.
Revised 07!1512014
F�BAENS FRONT ZONING B.JPUMSOR RANS VMEFAMN IFATURTLE MANGROVE
COUNTER SSAEII/ FSAB(V REVIEW REABN FBABN FEMN
DATE
i COMPLETE
INITIALS
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