HomeMy WebLinkAboutBuilding Permit Application DEC-28-20.15 MON 09 28 AM CENTRAL SCHEDULING FAX No. 321268613, _� r 02
Date. 1 L J� I Ix.,._ Permit Number: �T
Building Permit Application
Planning and DevelopmentServlceg
Building and Code Regulation Division
2300 Virg/nla Avenue,Fort Plerce FL 34982
Phone:(772)462-1SS3 Fax:(772)462-1578 Commercial Residential T•�
PERMIT APPLICATION FOR: To Select from dropbox,,click arrow at the end of line
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Address: n Cn n
Leg I Description:
ProperryTax lD#: 733 —Q Lot No.
Site Plan Name: _ Block No.
Project Name:
Setbacks Front ._ Back: Right Side: Left Side:
itiona work o nGasTank
orme un ert is perms --c ec a appy:
HVAC ❑Gas Piping 11_Shutters QWindows/Doors
Electtic Q Plumbing 05prinklers Generator 01 Roof
Tptal Sq.Ft of Construction: Sq.R,of First Floor,
cost of Construction:$ Utilities: 51 LTJ Septic Building height:
Nam Name.
Addr ss: ( Compan _ - -
Crty. I State: Address: 5-if r i
Zip Code: (EA.!P Fax: Cit Stat
Phone No., U2 Zip Code: Fax:
E-Mail: ie Phone No. �J�
Fill in fee si.n .Title Holder on next page(if different E-Mail 'CCYM
from the Owner listed above) State or County Lice se:
if value of construction is$2540 or more,a RECORDED Notice of commencement is required.
DEC-28-201 11 5 MON 09:2$ AM CENTRAL SCHEDULING FAX No. 02128$61$$ P. 003
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DESIGNED/ENGINEER: _Net 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 th subject structure
ItAhu is in conflict with any applicable Home{owners Association rules,bylaws or and covenants that may r%riot 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
ih accordance with the approved plans,the Florida Building Codes and 5t.Lucie County Amendments.
The following building permit applications are exempt from undergoing a fuiCconcurrency review:room additions,
accessory structures,swimming pools,fences,wails,signs,screen rooms and accessory uses to another hon-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,
Signat re of Ow rJ Agent/Lessee Signa re of ontractor/License Holder
STATE OF FI RIDA � /� STATE OF FLORIDAC - p 4
COUNTY OF (]"� C�� l COUNTY OF �.A L
The r om in��rumenY utas acknowled ed fare me The fr�r�,oing in ument was acknowledged before me
thisday of�`_CCSY11r._2?A 20.5bp this— .1 day of �2l], by
(N�personnowledging) (Dame v person acknowledging)
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{Signature of Notary Public-Sta a of Ida {,gnature of-Mofary Public-State of Fl a
Personally Known OR Produced identification_ Personally KnownA:�_OR Produced dentdication
Type of Identification Produced Type of identification Produced
�`_1�. catheri Kong ' r
Commission Na. _ Comsloa#FF1.7Z 720mmission NoC atf atkter3ne llCongBY'
Bxplres:OCT 28, i8 'TC;
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Revised 07/I5/2014
REVIEWS FRONT ZONING' SUPERVISOR PLANS VEGETATION SEATURTLF MANGROVE
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