HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLMD FOR APPLICATION TO BE ACCEPTED �S ! q
Date- ' d ' _ Permit Number.
Buildint Permit Application
Planning and Developmentservices
Building trnd Code Regulation olvlsion
2300 Virginia Avenue,Fort Fierce FL 34982
Phone:(772-)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Other
Address �• �- � �' ��� 4
Le al Description; �a
Property Tax ID#: 35a•'�D2 l ° OOH Lot No.
Site Plan Name: Block No.
Project Name'
Setbacks From Back: Right Side:. Left Side:
Y U ire.
i na Work to okme under s permit—c ec a app Y:
HVAC '�-#Gas Tank Das Piping _Shutters Windows/boors
11 Electric LJ Plumbing Sprinklers L l Generator Roof
Total Sq.Ft of Construction:_ Sq.Ft.of First Floor:
Cost of Construction:$ 'O l3tilities:[]Sewer Septic Building Height:
Will
Name 's r�, i(ICtA-k- Name: �1 t f�1
Address: ( Company: '
City: -Evil f'l State:� Address: _� S
Zip Code: r•.� Fax: City:, I n r
Phone No.�_7,i - 92-19 ' 12 Zip Code: 6g141"_ Fax:
E-Mail: Phone No. '
ff
Fill in fee simple Title Holder on next page(if different E-Mail: DL
from Cfwn
the' er listed above) State or' linty License:
if value of construction is$mb or more,a RECORDED Notice of Commencement is required.
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now pi I I
DE$IGNERJEN6lNEER:I ; Not i pplicableMORTGAGE c6mpA Ai: V--Not
Name: r Name:
Address:. Address:
i
City: i a I State: City: State:
Zip: Pho�n ; Zip:_ phone:
FEE SIMPLE TITLE HOt.lE : N•,tapplicable BONDING COMPANY: ' _j, Not'Applicable
Name: i Name:
Address: I l I Address:
City: may;
Zip: _ Pho e1 '
'Zip:
Phone•
I certify that no work or-installation has commenced prior to the issuance of a permit. '
r
St Lucie Coup makes-no r00esentation that_i granting a permit will authorize th10 permit,Holderto build the subject structure
which is imco ict with anyp{ licable Homel ers'.Assonation rules,bylaws or andcovenantsthat may rict or prohibit such
structure.Please consult with your Name Own rs Assbdation and review yourddecl for any restrictions whr may apply.
In consideration of the granting of this;reque k d permit,I do hereby agree that Cwlli,in all respects,perform the work
in accordance with the appri d plans,the Elorjda Building Codes and St.Lucie County Amendments_
The follwWrij b6ildi6g permit'pplications aie exet'rpt from undergoing a full concu}'rency reView:room additions,
accmory structure,,swim�l
Ig pgols,.fences,wails,signs,screen rooms and accesory uses to another non-residlential use
WARNING TO OUIINER::YQur failure tol Record a Notice of Commencer ie It may result is your paying tuuii�e for
impprovements to your roperty.A Ngtke of Commencement must b 'recorded and posted on the jobsite
before the first inspectlo�r. If you inteo 'to obtain financing,consult:�Ith lender or an attorney before
cammencin work or recvrdln our•Nq ice of Commencement.
m=Liy7 '�se/Agent rsintti# '#fGontator 41ense Holder
STATE OF FL4 ) !'
t�� I I STATE OF fLO
COUNTY OF
COUNTY OF' �
The oing inst ent wA i knowledge , e ore me The fairgoing iii Ment bcknowledged beforq me
this day of ZO y this day'* 1? 20 ":5 by I
(Name of person ackriouuledgihg) (Name of Pers n acknowledging)
A Flu
i I '• � i
a I l
(Signature of Notary Public!S to offlorI i i (Signatdre of N!fury Pub SCate,of Florida)
I
Personally Kn Personally Kin (I
Type of Iden ti ' d TAL,A EVED _ Type of Ident I cliff 1daT Agumbo,
•
Commission ltii ,' 44*)2019 Commission .` 5July f*10m,
owl a�e•o�ss r .eom c+ciaa !ss '
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLY
INITIALS
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