HomeMy WebLinkAboutBuilding Permit Application ALLAPKiCAtii E INF&m*tisr$£COpPiPWMD FM Al PUCATION'TO BE ACCEPTED
Cate: '!! Permit Number:
-Sulld Permlt-Applicattlan
Planning and DevelopmEnt Services
Bandl and Code tfegulation DWIon
2300 WrgkbAvenue,Frrt Pierce Ft.94M2
Phone:(772)462-1553 Fax:(772)462-1578 Commercial - Residential
L!'ERMITAPPUCA71ON FOR: Other
Address; 9 WO 6 . U13
Legal Description:[. q&(1&ftL-n C q—,
PropertyTAXID#: ° fn • QF - j lot No
Site Plan name: Block No.
Project Name:
Setbacks Front Bask: Right Side: _Left Side:
U AQ, -U"e, WT. TO 0 F-, 2-Vz IZ NJ
work to-bg 1&-Mrmed under this permit-checic all that appy:
Gas Tank OGas Piping _Shutters O Windows/Doors
OElectric 1___I Plumbing Sprinklers Generator Roof
Total Sq.R of Construction: /SOS s -Ft-of First Floor:
Cost of Construction:$ G i f • `� _ Utilities Sewer 0 Septic Building Height:
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Nam" Name: t tlr U.rL i' Y�
Addre s: lR.ft.. '3 Company
ti
City: lt,�,�l State:. Address:
Zip Code: ;34,q tJrl Fax: Caty' <L&ar tate:
Phone No- ` u- - 71 119 _ Zip Code; SMO Fax
E-Mail. Phone No.
Fill in fee simple Title Holder an next page(If different Ewa: ri? t Lt !Yi tL t.� • �`�
from the'Otemer fisted above) State or ounty License:
If value Ofeonstroction is$000 or more,a RECORdW Notice of Commeni:ernent is required.
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DESIGNER ENGINEER: ,�Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: ! Address:
City: State: City:. _____ _ State-
Zip: Phone: I-__ Zip: Phone:
FEE SIMPLE TITLE HOLDER: _._..Not Applicable BONDING COMPANY: ofApp(icable
Name: Name:
Address: Address:
City: City.
Zip: Phone: -- Zip: Phone.
I certify that no work or'lnstallation has comrpenced priorto the fssuance of a permit.
St.Lucie Courrrtrtyyma _ no rgpr�entation that'is granting a permit will authorize the permit holder•to build the subject S'rurture
which is imconflfet•t any•appilcable•Home OwnersAssoclation 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,I do hereby agree that I will,In all respects,perform the work
In accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications ark 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 0se
WARNING TO OWNER:Your failure to kecord a Notice of Commencement may result in your paying twice for
improSements to,your.property.A Notice of Commencement must be recorded and posted on the jgbsite
before.the first inspection.If you intend to obtain financing,consult with lender or an attorney before
comm6ncing work or recordin ' our Notice of Commencement.
S
zc a see/AgQm S at re:tsh, r or License Halder
STATEZF FLO ! STATE OF FLORI
COUNTY OF COUNTY OF
The inst ent we acknowledged before me TheVday,of
g instruryient Was ackn wledg ore me
this o�d+1�'ay of` � zo l by this
(Blame of person acknowledging) (Name o perso ji
acknowledging)
I- Ii
(Signature n'f Notary Publf�-State of Florida) (Signature of Notary Public-State of Florida)
i
V/
Personally Known OR Produced Identification Personally Known _,„ ROR Produced Identification
Type oflldentifi Type of Identification Produced'
C1aYSTA4 CRY�UEvEoo
Comm[ ;w tIAY r_oMM I=B►_$BION#FF�� Commission No. .a ..MY c0 #FFsoaoa6
EXPIR3ufy a1. . I ; ,
1oa ecn a EXPIRES July 31.2019
140/1 -0• 14CII3911-0�S9
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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