HomeMy WebLinkAboutBuilding Permit Application PPIUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1509 ,- 603
Gate: Permit Number:
Building Permit Application
Planning old DeWopmentStrvlces
Building and Code Regulation Division
2300 Virginia Avenue,Fotr Pierce FL 34982
Phone:(772)462-1553 Fax(772)462-1578 Commercial ZResidential
PERMIT APPLICATION FOR:
Address-,
Legal Description:
Property Tax JDA: 60 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back* Right Side: Left Side:
14clitionalworKtOtieperrornlecl under is permit-ccK all-triat apply:
_-Mechanical -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:$ 7 Utilities: -Sewer -Septic Building Height:
Name C2,".n2,IL\=,'Jp� "o(X\& Name- -SXMMO-0,5-
Address:quA1-1XvLJ-1) -"101- company: CkAg-rgtt Gf- S'4J5+fWJ
city: 0-3—ej —State;_EL, Address:- WS SS V i l l a a-QrwrJ)C-
—
Zip code. Fax. city.. PORT ST Lrn,- -,t2te-
Phone No. T1,a Zip Code: IF= 177A -33LiILL-
E-Mail: - . aL - - . Phone No. 77,E .5 -39-31
Fill in fee simple Title Holder on next page(if diffiarent E-Mail- C-uAt
ear CW
from the Owner listed above) State or County License: -A
if value of construction is or more,3 RWORDED Notice of Commencement is required.
MIN,
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Add ress: Address:
City:_ State: City: ,
Zip: Phone: State:
. _ -- .._ Zip: Phone:
FEE SIM PLIE TITLE HOLDER: —Not Applicable 116I90ING 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 Counmakes no representation that is granting a permit will authorize'the permit holder to build the subject structure
which Is In con,7ict with any applicable Home Owners Association 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 I will,in all respects,perform the work
in accordance with the approved plans,the Florida Buildipg Codes and 5t.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.
ot
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S7 L U C 1 e COUNTY OF e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of _ _ ,20� by this day of ,20_ by
Cur �i5' S � mria ornS CUArrs n &z?, C-
(Name of person acknowledging) (Name of person acknowledging)
'(Signature of Notary Public-Stat0of Florida) (Signature of Notary Public-State of rida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced__ Y P p�awra►t5H Type of Identification Produced
eY cor�w+lssiaN �a
Commission No, �� s9 �y * gal �i '"v CFfi�lb"MIEB.ENGLl
EXPIRES:�pri14,2917 Commission No. � 1PuFyd�y * MYC4i ,lI99iQN YEE
rm%*N*4 " y EXPIRES.,
�� Badd
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
l (=►bIC QSA �176b Cg_-