HomeMy WebLinkAboutBuilding Permit Application 11/12/2015 10:03 7727811307 FLYNNS AC PAGE 01
FLLALPE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:RECEIVED NOV 121015
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fart Pierce FC 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line V c�C
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Legal Description: l�y+(AGOG' - _�" �
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Property Tax ID#: So• Lot No._L2.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional worK TO ormed under tispermi checK a appy:
Zi SUVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
11 Electric ❑ Plumbing ❑Sprinklers El Generator 0 Roof
Total Sq. Ft of Construction: 5Ft.of First Floor: _
Cost of Construction:$ t Utilities t Sewer Septic Building Height:
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Name Y ` Name: V1 I
Address: Z I Company:
City: State4� Address ;�
Zip Code: Fax: City: Stater
Phone No.li(k -10--.2- Q('61 19 Zip Code:3 Fax: 772 7$'(--130
E-Mail: ~~ Phone No. '2 (!
Fill in fee simple Title Holder on next page(If different E-Mail: 01!Qvilog .4
from the Owner listed above)
State or County License: ' •
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
11/12/2015 10:03 7727811307 FLYNNS AC PAGE 02
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State:— City: State:
Zip: Phone' Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: ^Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.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,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 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 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
commencing work or recording our Notice of Commencement.
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sigpdt&re of ner/Lessee/Agent Sig of Co ctor/License Holder
STATE OF FLORIDA STATE OF FLORI A
COUNTY OF iMPAca COUNTY OF (ARA 4n
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this t day of Ak!)A9 (�y 2Q by this day of (�rlY 4 h,20 I by
(Name of per on acknowledge g) (Name of pers n acknowledging)
(Signature of Noof Florida) (.Signature of Notary Public-'State of Florida)
Personally Known_OR Produ deW* 10 Personally Known OR Produced�ttkr
Type of Identification Produced Type of identification Produced W -
1 �OF
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Commission No. STFk� 1�
+ 1011RA Commission No. 9m
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS