HomeMy WebLinkAboutBuilding Permit Application i
,iPPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: uta Permit Number: ` t�
_.
Building permit Application
Planning and Development Services '
Building and Code Regulatlan Division
2300 W ginio,Avenue Fart Pierce R 349e'
Phone: (772)462-1553 Fax:(772)462-1678 Commercial Residential
PERMIT APPLICK11ON FOR: V
Address: r!°�we /V?m f ix.e .[ ,�a �►` - ', Z
Legal Description: --
Property Tax ID Lot No.
Site Plan Name: dock No.
Project Name:
Setbacks Front.. Back: Right Side: Left'Side: _
1`0 A
na wor a e pe rme under is perm –c ec a a apply:
Mechanical _,Gas Tants _Gas Piping _Shutters Windows/Doors
_ Electric Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: Sq.Ft.of First f=loor.
Cost of Construction:$V� "'� Utilities: _Sewer ,_,Septic Building Height:
Name .rdinti{os Name: Ctwics, _. alt.S- ,
Address: twig /sem / 04 Company: 1sxa A Cr Skislems )&Lr–
City. & -r Xy Ger State: � Address. 14-1� _r
21p Code: ` .S"� ' Faxc City. pun 5T, C t e state. EL.
Phone No. zip Code: __ q .+_ _ Far.
E-Mail: Phone No. 7-7a ^3902
Fill in fee simple True Halder on next page(if dl ferent E-Mail: c_,,�,T cf, S H'z V ,Ao I.f M .
from the Owner[load above) State or County License: _ CRC 05 J g,LQ—5-6u
if value of construction is2sWor more,a REWRDED Notice of Commencement is required.
7 �
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DESIGNER/ENGINEER: �._Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City. Stele: City: State,
Phone: Zip: Phond:
PEE SIMPLI:TITLE HOLDER: Not Applicable y BONDING 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 County�makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in Gpriflict with any applicable Rome Owners Assoc�at�on rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your(come 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 St.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 faildre 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.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF .`7 VCif COUNTY OF,' 67 Lycr e
The forgoing instrument was acknowledged before me The forgoing instrumentviasacknowledged before me
this day of .. _ ,20 by this, day of _.,20.t by
Pu d i c a-m 1m o(1 c
(Name of person acknowledgng) (Name of person acknowledging)
Y
—tl�ivz &
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(Signature of Notary Puubilc S of Florida) (Signature of Notary Public State o rida}
Personally Known✓OR Produced Identification Personally Known. OR Produced Identification
Type of Identification Produced 8 F=Bi Type of Ident'i0cation Produced
�•r ' MYiKIiI>�S�1iiEE ���': �811r>E9.
Commission No. � �s h y * &I) EXPIRES-A04,24t7 Commission No. '1f f�d� li1'{COgft 8lbN#ra
0eneeElMiBuiprtltat�lr ,�'� i<XPIRES:apt�A,2a#
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
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