HomeMy WebLinkAboutBuilding Permit Application .PUCABLE INFO MUST BE COMPLETED FOR APPLICATIC CTO BE ACCEPTED
Date: ra� Permit Number.
RECER.10- JUN 18 7D b
i
Building Permit Application
Planning and Develapment Services
wilding and Code Regulon DUslon
2Y00 Virginia Avenue,Fart Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: c\�,
Address: 11910 a/ ?
Legal Description:
Property Tax ID#: _ /, G?. C�?. -cd�' '" Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front--. _— Back:_ _ __Right Side: Left Side:
Additional Work to be performed unclertnis perm --check all that appy:
Mechanical . Gas Tank Gas Piping shutters Whitlows/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 t Name: _ CAmts Sa vn�rt�rLS
Address: ! y�' �� �' .P�.�cCompany: C Ac ztga Air &,,+e m c ).&C-
/41
02 state:F'z- Address: ll-l S 5& V1
Zip Code: Fax: City: V4QT ST L—kC . State: L.
Phone No. Zip Code: 34 M Fax: 7U 33S I�4 9
E-Mail: Phone No. 77 33,5 -3ai-i
Fill in fee simple Title Holder on next page(if different E-Mail:- -- C.ut-P tic SS4"p Co).6m ---
from the Owner listed above) State or County License: C Q -414 - 5
If value of construction isZWor more,a RECORD!D Notice of Commencement Is required.
■
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name. Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phond:
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 Countv makes no representation that is granting a permit will authorize theermit holder to build the subject structure '
which is In conflict with any applicable Home Owners Association rules,bylaws or anscovenants that may restrict or prohibit such
structure.Please consult with your Horne Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,l do hereby agree that I will,in all respe'dts,perform the work
in accordance with the approved plans,the Florida Buildiip$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 failure 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/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S 7 I--V C I e COUNTY OF 5 T
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 17 day of rix_ 20/S by this/7 day of
20.1f by
urf s :y4m M Ofis CUA-
(Name of person acknowledging) (Name of person acknowledging)
7
(Signature of Notary Public-Sta of Florida) (Signature of Notary Public-State of rida)
Personally Known ✓__ OR Produced Identification Personally Known OR Produced Identification
Type of identification Produced ��mp Aare ffi Type of Identification Produced
% MY GdMMINION 1 EE W -AtRy
Commission No. *al) EXPIRES:Apip 4,2017 Commission No. dP,f�yljdl I/ MY
ON
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EXPIRES:Apiil4,20t
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SCA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLE'T'ED
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