HomeMy WebLinkAboutBuilding Permit Application 06/25/2015 11:36 7724663737 BOYLEAC PAGE 01
ALL APPLI INFO MUST lig COMPLETED FOR APPLICATION To BE ACCEPTED �I
Date: Permit Number: A 5bro -6 1�s
w RECER"H0 JUN 2 5
Building Permit Application
Planning and Devai*"nt services
Sullding and code Regu/adan Dlvbkn
2300 ftinlo Avenue,Fort Pkme FL 34982
Phone:(772)462-iSS3 Fax:(772)463457$ Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line v ��
PROPOSED IMPROVEMENT LOCATION:
Address: ltprrinp
Legal Description: ABix [
..�.
Property Tax Ip N: a .2- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _Right Side: Left Side:
DFTAILED DESCRIPTION OF WORK:
'4/4 "7 Kw 44eat
CONST CTION INFORMATION:
Ad
a ora error! un r s perm - e a appy:
HVAC Gas Tank as Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers Generator HRoof
Total Sq.Ft of construction: /� R.of First Floor:
Cost of construction:S 3"I/,�q It D 0 Utilities Sewer 11 Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name:
Address: ��d �YnO company: `
City: State: Address• '
Zip code: Q,5 I Fax _ Ci State
Phone No.mft� 478- Mug - _ ,_---_-_--- zip Code: � Fax:����t!o�•t�73�
E-Mail: Phone No. -l'7a_� QI� ( �
Fill In fee simple title Holder nn next page(If dWenwt E-Mail:
from the owner listed above) State or Coun license:
If value of comimcdon k S25M or more,a RECORDED Notice of Commencement Is t etlulred.
06/25/2015 11:36 7724663737 BOYLEAC PAGE 02
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
bESIGNE ENGINEER: _Not Applicable MORTGAGE COMPANY: Y 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:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County malts no represent . that is granting a permit will authorize the permit holds to build the subject re
which is in conflict wine anyy appllable Home Owners Association rules,bylaws or and covenants that may restrict or prohi%such
structure.Please consult vrith 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 I will,in all respects,perform the work
In accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The follovAng 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 paylryl 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
commencina work or recording vour Notice of Commencement.
�
5lgnature er/Agent/lessee Slgnature of Contractor/License-HdTdeir
STATE OF FLOA�� STATE OF FLO�QA
COUNTY OF COUNTY OFT–t- W,6—
The forgoing instrument was acknowledged fore me The forr��o-ing instrument was acknowledged before me
this ay of I-V AAA , RO�1ry this day of'flL11Q•__-__---2- mg-hn &Anelli6ien 10,
(Name of pe owledging) (Name of person acknowledging)
n • � �icXr"
(Signature of N ublis State of Florida) (Signature of Nota blit-State of Florida
bl )
Personally Known ✓ OR Produced Identificatic n Personally Known. y/ OR Produced Identification
Type of Identification Produced Type of identification Produ
CHRIST
INE NWE.L.I- Cammissi CNRIg�IN�, M b
Commission N ._.. MI--I �0 MiBB
tuft 11,201
IREf3 K 71,1014
Revised 07/
REVIEWS FRONT ZONING SUPERVISOR MANS VEGETATION SEA TURTLE MANGOMF
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS