HomeMy WebLinkAboutBuilding Permit Application .,PPUCABLE INFO MUST BE COMPLETED FOR APPUCATION'TO BE ACCEPTED
,Date: U -a �� Permit Number: I`'Q� v 21
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue,Fort Pierre K 34992+
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID#: ��y-✓`Ql- '�� Q d Lot No.
Site Plan Name: Block No_
Project Name:
Setbacks Front Back; Right Side: Left Side:
z4k 411- 46 jf.��.�1 �
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Add�
,ona workto a performed under this permit-c ec a at appy:
Wechanical _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: _„_Seaver _Septic Building Height:
Name Wr'•er�co hu i Name: Cuc is Sawt_rnort_s__.
Address: 17114ed1-6Pr4n1p, /'JfVd• Company: (aAS'T-y x -Lr ? SfiwfS�r�lCr
city: Pam•% -t_ G_lC_�- -- ---F7- _ _State:_ Address: 15 $E `V i I(ct_q q rwrt Dr -
Zip Code: Fax: City: poel�T Lkc ie--� State: rL.
Phone No. S'y�-��-�pZd/ Zip Code: 34�5,Z Fax: q?a 33.5. )US
E-Mail: Phone No. 7'77
Fill in fee simple Title Helder on next page(if different E-Mail, —t,2,lr �
from the owner listed above) State or County License: Cfl C 0 5 rrS 1 C ' SiaiQ '
if value of construction is2Aetror more,a RECORDFO Notice of Commencement is required.
14.
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DESIGNS ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Nar'ne: Name:
Address: Address:
City: State: .City: 5tate-
7!p:, Phone: Zip: Phond:
• a
MPtIE Tf LE HOLDER: _Not Applicable 0611101ING COMPANY; _Not Applicable
Na' e•. 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 Coun makes no mpresentation that is,granting a permit will authorize the hermit holder to build the subject structure
which is�n con lct with any applicable Home Owners Association rules,bylaws or and ooveriants that may restrict or prohibit such
structure.Please consult v6nth your Horne 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 respeft ,perform the work
in accordance with the approved plans,the Florida Suildipg Codes and 5t.Lucie County Amendments.
the following building permit applications are exemptfrom ulidergoing a full concurrency renew:roam additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your faild a to Record a Notice of Commencement may result in your peong 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
commendrig work or recording our Notice of Commencement.
at
1 1 II���II
Signature of Omer/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF r V Cir COUNTY OF• CT Lo C, e
the f irgoAL d g instrument was a knowledged before me this forgoing instrument thass acknowi ledged before me
day -fit 01-4 / y
�urfr5 5 mma � J a26V W0*4
(Name of person acknowledging) N 1
� ame of person acknowledging)
i
{Signature of Notary Public-SltaWof Florida) (Signature of Notary Public-State nda)
Personally Known OR Produced Identification Personally Known ,,'/ OR Produced Identification
Type of Identification Produced CfSMType of Identitic don Produced
Cornmission No. 8 � �y * lY'fCA1 10KfEE . , � #FiB11iiE8
t��8eededthtr8od�ttk�ir Ot7 Cornmissirm No. * ,�IlyrdNfFE
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SF-4TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW! REMEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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