HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST$E COMPLETED FOR APPLICATION TO BE ACCEPTED '509
Date, Permit Numbe `t
'i
Building Permit Application
Planning and Development5ervices
Building and Code Regulation DiW910n
2300 Wrginla Avenue,Fort Plerce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Other
110.
Address: TIE 90I
Leg'alDescription:Zhla-nd 'bune 5 OcQan�►d Can o�►i�►,.�.rn 1 i l.�i+ ISD
Property Tax•ID#: —:;S JU0 2 ' Dl 1 A ' 000 Lot No._
Site Plan name: Block No.
Project Name:
Setbacks Front_ Back: Right Side: Left Side: _
OEM=
TO Ate, 4LP G!2
t o wor a t oerforme un er this perms —c ec a app T
AC has Tank Gas Piping Shutters ❑Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: 1 3-1 _ SFt.of First Floor:
Cost of Construction:$ 00 Utilities t Sewer 1-1 Septic Building Height:
all
IM
Name (�i 0 rl.Q,. Name: IY1
Address: . � ' ` Company: IGUri•�:71
C•Ay; State: l-� Address- i)a'�
Zip Code:' .W __ Fax:
1 City: tate:
Phone No. Zip cod a• Fax-
E-Mail, Phone No. cam-
Fill In fee simple Title holder on next page(if different E-Mail: ap,
from the Owner listed above) State or'County License:
If vidue of construction is'$-2 00 or more,a RECORDW Notice of Commencement Is required.
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DESIGN IENGiNEER: Not Applicabie MORTGAGE COMPANY, "p7
Name: Name-,
Address: Address:
City: State: City: State:
Zip: Phone: . Zip: Phone:
FEE SIMPLE TITTLE FfOI:bER: N&Appllcable BONDING COMPANY: — ot'Appiicabie
Name: Name.
Address: Address:
City: City:
Zip` Phone: Trp: Phone:
I certify that no work of-installation has commenced prior to the issuance of a permit.
St.Lucle Counttyy makes no represenr�tation th6t Is granting a permit will authorize the ermit holder'to build the subject structure
which is In.corifiict with any appilcable'Home:Ciwners.Assocratibn rules,bylaws or anIt=nants that may restrict or prohibit such
structure.Please consult with your Hone Owners Assbciation and,review your deed for any restrictions which may apply.
In cori0cleration of the granting of this requested permit I do hereby agree that I wIII,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 full concurrericy 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
improirements 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-recordineyour Notice of Commencement.
`
NOW',fz Agent ` gnat+it e;4.�br tr Or License ff lder
STATE OF FLC>e STATE OF Fi.ORID _
COUNTY OF � �"�`!TVII�.� COUNTY OF
The f oine i en was acknowledge ' efore erre The fci oing instru ent was ackn I ledged ore me
this day of 2Q th#s, day'of 20 _by
(Name of person ackriowledging) (Name of person acknowledging)
Gwi,tit)
. .
(Signature of Notary Public-State of Florida) (Signature of N.atary Public-State of Florida)
A�'UUEYCUV
Personally known " c(uce # errti cap ;Personally Kno n.+� Y A �f7�R Pty 4n
Type of Identificatio ' RYBT!#t'atiev(I' Type of Iden ed fit I&OP411
ola►y;� c• 9 of Florida M • r�MY G9mrlr.I xifres d 31.'2015
My Cc
Commission Na. r+ r1Dlrg6.luh91.''2I?15. Commissionminls'slon .7x476:.�
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$Slorr r~ r
Revised 07115/2014
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETA11ON SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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