HomeMy WebLinkAboutBuilding Permit Application All CA93 i W.W)S7''WCOAkffEE?'FM APPUCATM TOO Atm
Date: "l Permit Number.
RECEIV7D JAN a6 2016
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Buildidg&nd'COde'tteglila bV DAI&lon ; /
2300 Virginia Avenue,Fort Plena FL 34#82 V
Phone.{T7aZl 452-1553 Fax:(772)462-1578 Commercial Residential
'PERMIT r
Address: 400T I .
cdpt : I � �a 1"L)
Rt>IV Shia.. in 0-omm -I•e ryxgr
-P'rop�erty Tax iti t�: �'5 35 , �2. 00-1--;5QQf� f lot No.__
Site•PRlan Name: Block No.
Project'Niari e. RNL�
Setbacks Front Back.: flight Side:�left Side:
rme un eriNagspiping
O
arit
hfVec a apply.
AC ''� Gas Tank _Shutters Windows/Doors
"'
Delectric ID Plumbing OSprinklers OGenerator El Roof
Total Sq.R of Construction: So.Ft.of First Floor.,
Cost of Construction:$ A I SC 3 P D Utii-ities. Sewer 0—Septic Budding Height: -.-
NaPne Name: n
Address: Company: .t rtA 41�. .
State:LL Address: 109 MILIsya-e-
Zip Code: 14 Fax: City:_StU A t�I"
Phone No. X05-b-03 -151 4 Zip Code: 3Y
E-Mail: Phone No. 10A.9560
Fill In fb+e sir 4ft7-ffle leder on'nett page'(if different E-Mail:
from W-e-Oarner lam'ahave) State or'Coitnty Lkinw.
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WJDE lGf+i j NOINEER: Not A0piicable MORTGAGE COiMPANY: Not Appiicabie
Name: Name:
Address: Address:
My: State- __-- City: State —
�..�.,� � _
Zip: Phone: Zip: Phony:_ _
FEE SIMPLE TITRC HOLDER: _Nat Applicable BONDING COMPANY: oti'Appiicable
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 Caunl m6k(�no representation that is granting a permit will authorize the permit holder-to Wild-the subject structure
which is invon ict•wsu any pplicable Home OwnerssAssoctation rules,bylaws 4Qrand pcovenants that may,restrictar prohibit such
structure.Please consult wit your Home Owners Association and review your-gleed 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 exel'npt 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
WARNING10 OWNER:Your bilore 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 rec riding y our Notice of Commencement.
S a ure: r or 13cense Holder
_ -
`. x. essee/Agent `�,.}
STATE OF FLORI _ ._r J __ STATE OF FLORIDA f V p L rt L, _
COUNTY OF 1111 UULT Vv� COUNTY OF l U l L �
The f1poing instrument was acknowledged before me The rgoing instru nt was acknowledgeqd� before me
this day of 20 j(pby thisW day'of 20410—by
b 5 ` �G Cr s+C Qua
(Name of person)acknowledgin ) (Name of person acknowledgin
(Signature of NotaryPublic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known " OR Produced Identification Personally Known OR Produced ldentif+tion
Type of ldenti Type of Identiflc
F9040�8
Commission N . WSTAL fM Commission No. ~ MY EXPif�CCI MEB 2019
EXPIRES Aq 31.•2^^ +019 !w ploric�►ro�rysarvws eam
Fbgb{r(Gio &9rYk0A0a' .
Revised 071.15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
CQMPL�
INITIALS
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