HomeMy WebLinkAboutBuilding Permit Application r.
,.pPLICABLE INFO MUST BE COMPLETED FOR APPLICATIONTO RE ACCEPTED
'Dater��``� Permit Number:
RECEIVE-D JUL 23 2015
Building Permit Application
Planning and DeVOOpment 3eruices
Building ornd Code Regulation Division
2300 Virginia Avenue,Fort Pletce Ft 34982
Phone:(772)462-1553 Fax(772)462-1538 Commercial Residential
PERMIT APPLICATION FOR:
Address: 7 i' � ` / J00RZ, ,��`' . . AX
Leg24 Description:
Property Tax Ica#; 2 -17 lot No,
Site Pian Narfne: Block No,
Project Name:
Setbacks Front_._ Back:_r _Right Side: Left Side:
/91 seer
ona worko e pe rme un er
-his—perm c ec a app Y�
Mechanical Gas Tank Gas Piping Shutters Windows/Doors
._.Electric Plumbing ,r Sprinklers Generator Roof
Total Sq.Ft of Construction; Sq.Ft.of First Floor:
Cost of Construction:$ '�� utilities: —Sewer !Septic Building Height:
Mamefie/ 1 i Mame: -Curtcs ,Srummon.5
Address: /4 'd'0 L G�.r�a eK Company: xaa-rarn A "r u S Feinc } :r
City: _ _./�� ,r_ �C�c,� r�G State: Address: _i�r!_S S� `111_Lt res_�r.�rt Pr
Zip Code: Y�ficr7Fax: City: tt�Q.T._ T L1� tt� St2t : �-,
Phone No. r�°?�'S; �'cP Zip Code: 34„ Fax; 7'7a 32, 114�
E-Mail: Phone No. 77eg3-4
Fill in fee simple Tine Halder on next page(if dWer+ent E-Mail: _ c d a o 1,c M
from the Owner listed above) state or County license: Chi C 0 S! 1 fJ -S41�te '
If Value of CO"StruCtion 1$25W0r more,a RECORDED Notice of Commenornent Is required,
7�',O
DESIGNERANGiNEER: Not Applicable M01RTGAGE 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: Phona:
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 prier to the issuance of a permt
St.l,ucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is m conflict 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 Bulldivi Codes and St.Lucie County Amendments.
The fallowing building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,suns,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
commenein work or recording our Notice of Commencement.
Signature of Owner/Agent/Lessee 'Signature of Contractor Holder +
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S 7 L.-v C I e COUNTY O 5TH.
The forgoing insWment was acknowledged before me The forgoing instr nt vias acknowledged before me
this..,day .2o,� by 'this day of-�_ -- 26ff by
u r fi s' Sm rn anS _ CUA Tj; C.
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Sta of Florida} (Signature of Notary Public State of ride
Personally Known/OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced r pub. Type of Identification Produced -
alj EXplAE82 Apt114 OOV Commission No. � B"fW V
Commission No. �i~�5��3�Y +• � #IYCiBtIt0lltEl's Il�E�,
''F Saendran�ut t i *� AlyGtllAill$I #�
' a� EXEs.Aptq.4,tp}
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RATE
RECEIVED
DATE
COMPLETED
Re—v.
� � /