HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: lt7 ' �'� Permit Number:OWN
Building DECEIVE®Permit Application -
Planning and Development services JUN .18 2015
Building and Code Regulation Division
2300 Virginia Avenue,Fart Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
Property Tax ID#:q5b7 ' Z> • '.� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:_ Left Side:
-` rJ2- CO
do wor o e Orme under is permit—c ec a app y:
HVAC E]Gas Tank ❑Gas Piping n
Shutters 7Roof
ws/Doors
Electric Plumbing Sprinklers Generator
Total Sq. Ft of Construction; Sq. Ft.of First Floor,
Cost of Construction:$ Utilities:USewer OSeptic Building Height:
Name ^y-1
Name:
Addr s -
Company; ,
C��' State Addres •
Zip Code: r
Fax: City:
Phone No. •1. State. -
ZIP code:
E-Mail: Phone No. �] • -}(„p ( ,
Fill in fee simple Title Holder on next page if different E-Mai: c' M
from the Owner listed above) State or County Licehse:
If Value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
. a
800/100/2 39IA83S*A9019v3*OavAOae L89L19VzLLL Xv3 89:ZL 4LOZ/81/90
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SPIN
PES16"WRNGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State
Zip: Phone' Zip: Phone:
FEE SIMPLE TITLE MOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone• ZIP. Phone:
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 wit)authorize the permit holder to build the subject structure
which is in conflict with any applicable Marne Owners Assoaatton rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home 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 1 will,in all respects,perform the work
In accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a fell 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 Commencelent must be recorded and posted on the jobsite
bef a the first inspection. If you ntend to obtain financconsult wit lender or an attorney before
com encin w din r Notice of Commenent.
Slgnat a of C( see Sig re o Co tra ice se Hold
STAT OFF 0 A �7 5`CA E OF GRID
COU 0 COU OF
The f sing instrument was cknowledged be ore me The f Ing Inst ument was cknowledged before me
this 1 day of , A 20 1 by this
of i( 2t) by
r-�
(Nam _P Alu
e of pe rs acknowledging) (Game af_person cknowledginS l
(Signature of otary Public•State of Florida tggature of ary Public-State of Florida)
Personally Known t OR Produced Identification Personally Known� /'OR Produced Identification
Type of Identification Produced Type of identification Produced
Commission Na. :1 "' �., �FR Y i,Commission No. 1 @
� NNE RUSSELL c JEHA h1N RI.�'-•.
�. .° Notary Public•Stale of Flooda '; '.`�= Notary Public•Stab•1I h„u.:1
Revised 1)7115/201 `;RI°.�, "�4, commission#FF 038392 -�f; p,�t `- Commission #FF 039342
1,11111
REVIEWS FRONT ZONING SUPERVISOR. PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
800/ZOoln 33IA83S*A8013d3*08VA088 LE91.1.9tZLLL Xy3 b4:Zl SL0Z/8L/90