HomeMy WebLinkAboutBuilding Permit Application ,ppU BLE INFO MUST BE COMPLETED FOR APPLICATIO 'TO BE ACCEPTED
Permit Number:
Building Permit Application
Planning aqd Development Services
Budding and Cade Regulation Division
23W Virginia Avenue,bort Pieme FC 34982
Phone:(772)4.62-1553 Fax:(772)462-IS78 Commercial� Residential
I�FRMIT APPLICATION FOR:
Address: "o all1i >
Legal Description:
Property Tax 1D#: � � i'�D���l7 / Lot No._
Site Pian Name: Block No.
Project Name:
Setbacks Front back: Dight Side: . Left Side:
�.—..:-.....,n �... IF 0 /It L-I/ r
Ilonaor to performed un er is perm -�c & a appy:
_,/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:$ Utilities: _Sewer _Septic Building Height:
Name v 12 Name: towns 5WmI rI.5
Address: fyd � Company: S�..# t._� r �s e»�rt �iuc.
Clty-��, � --- State: fAddress: 4-d5 Vi lQ r ---- r .
Zip coda: Fax: City: "C r x.,11 C i —State:
Stater
Phone Zip Code: 34 Fax: 17a. 33-T-)I� _
E-Mail- Phone No. 772 - X3.5 •-3932
Fill in fee simple Title Holder on next page(if different E-Mail: c-tLstgsc- c Wj,*o 1.c.
from the owner ifsted above) State or County License:
If value of construction ts3$'9r more,a RECORDED Notice of Commencement Is required.
700
e,
y
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State. City. State:
Zip: Phone- Zip; Phon€:
FEE SIMPLE TITLE HOLDER_ i Not Applicable 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 iaork and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit
Str Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in 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,l do hereby agree that 1 will,in all respects,perform the work
In accordance with the approved plans,the Florida 8uildipg 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 failure to Record a Notice of Commencement may result in your paying tawlce 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
COUNTY OF L-V C t ? COUNTY OF,,. —5- Ly
The forgoing Instrupignt was acknowledged before me The forgoing instr ent was acknowledged before me
this..this.JU.day of 1""""20/
by this 2.7 of ., •20,E by
---- _ U r f i S 4)n m a ris-
(Name of person acknowledging) (Name of person acknowledging)
(signature of Notary Public sta of Florida 7 (Signature of Notary Public State of ride)
Personally Known OR Produced Identification Personally Known e' OR Produced Identification
Type of identification Produced Type of Identification Produced
IIY
t u SQ , S�
• # �fiE
Commission No. I) EXpIRi:s:Ap�l4,a0IT Commission No._G—�1PS9���' PE&EWA
* � W00AA=I0m#EEJN
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW/ REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.772014