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PPLICABLE INFO MUST BE COMPLETER FOR APPLICATION'TO BE ACCEPTED
Date, Permit Number.•
Building`
0,�,�S
Building Permit Application
Planning and DeVelopmentServices
Building end Code Regulation Division
2300 Virginia Avenue,Forr Pierce Ft 34982.
Phone:(772)462-1553 Fax: (772)42-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: q9q9
Legal Description:
Property Tax ID#:
Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side.
a�CbrA r SKL.�
Additional work toThe pertormed under this permit-cneCK all that apply:
—Mechanical ^Gas Tank Gas Piping Shutters Windows/Doers
Electric Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: Sq. Ft,of First Floor:
Cost of Construction;$ `�q 9 .Ot) Utilities: —Sewer Septic Building Height:
Name 60LO�<V-81, I-A 'Name: curi!,6 sawinon
Address: 'UO W i 61-k-- mo Company: C&5,arh_ A I t'r Sc4s+8M5.
City; State:1�4 Address: (� n
Zip Code: �A�atLta_ Fax: City; pop_-, 5-T Lisle. C-1- State;
Phone Ivo. zip Code: Al�z - — . Fax-._. q7,2
E-Mail: -Phone No. 7712 113S _3al
Fill in fee simple Title Holder on 'next pa& if different E-Mail: C=&sty_yr 4u Co I
from the owner listed above) State or County License: UCOSIR10
if value of construction is 25eTor more,a RECORDED Notice of Commencement is required.
AD
DESIGNER ENGINEER: Not Applicable MQRTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
State: City: State:
Zip:- Phone: Zip: Phond:
FEEAIMPLE TITLE HQweit: _Not Applicable 96NIDIF46 COMPANY: _Not Applicable
Name;,, Name:
Address:_ Address:
TiCity: Phone: dip. � Pilon®:
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 bas commenced prior to the issuance of a permit.
5t.Lucie Coun%makes no reprepr on that Is granting a mit ill authorize the permit holder to build the subject acture
which is in con tet with any app icable Home Owners Assodiation rues,bylaws or and covenants that m$y restrict or prohibit such
structure.Please consult with your Home Owners Assoclation and review your deed for any restnctions which may apply.
In consideration of the granting of this requested pemsit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Suildipg Codes and Sir Lucie County Amendments.
The following building permit applications are exempt from uhdergoing 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 f Wre to Record a Notice of Commencement may result in your pwfing 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
commencine work or recordina vour Notice of Commencement.
signature of owner/Agent/Lessee Signature of Co ntractor/license Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S T L L;C l e COUNTY OF.,. 5-r Loci e
The forgoing instrument was acknowledged before me The Forgoing instrument was acknowledged before me
this day of _ '20— by this�day of 70_ by
v r f!S' J A man CWq 7ts�
(Name of person acknowledging) - (Name of person acknowledging) _.
• ,
(Signature of Notary Publio-Staea Florida) {Signature of Notary Public-State of rids)
Personally Known DR Produced Identification Personally Known OR Produced Identlfleation
Type of Identification Produced .%w via, --- Type of identlfltadon Produced
MYCOWSWItEEM
Commission N0. EXPIRES:Apd4,2017 Commission No.,,��d�u��ilr�y
Aa+didnr° 7
EXPIRES:A d
• �,,� Pd .20f
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLEI'EI�
rev:7/21314
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