HomeMy WebLinkAboutBuilding Permit Application Jan 07 ZO16 13:36:05 Via Fax —> > Vonage Page 002 Of 004
ALL APPLICABLE INFO MUST BE,COMPL•STM�t3td,i%�'FLiC�Ttf�11d•TfS:�l::i�CIC�pYE63 ;:;::.: : : :
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Building Porml .ppl�ca. r�:....
.Planning and Development Services
Building and Code regulation Division
2300 Vlrginla Avenue,Forr Pierce Ft 34582
Phone:(772)462-1553 Fax: (772)462-1578 Commercial : Residential
PERMIT APPLICATION FOR. To Select from dropbox, click arrow at the end of line
Address: Cooavl �a V /_
Legal Oestri tion: ,r` .r ,�
Property Tax IU#: A-3 U - ;-34 1200A_- ocyo 7. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: ....'.... . .... '..Left Side':'
P2 ANIIN
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PQor to e e Orme un er is perms —c eC a app y:
HV�dC Gas Tank Gas Piping _Shutters Win'dowsfDoors
Electric Plurnbing Sprinklers Generator Raaf '
Total Sq. Ft of Construction: ao �,u Sq. Ft.of First Floor:•.
Cost of Construction:$ sa� _-- Utlllties:LJ Sewer Septic`.•`` Wing-Height;
l�iarne• '' c - �d Name::'.;. 1 4 "�► C1 eAl"°'
�Ad;�ress: � � ��.��.'� �,.�__�.,,_ 'G�"r�pany_••.�. , �;. .� .� ��'��.•t �1. ,�. - �j,
'. ltj�.; _ Stater A��i�ress: � �
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fax: City;'~.•': `" 5tate:.�,
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Phone:Nti: c c �� zipCbde:: .. = Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:. r C��?� I ,Com, .
from the Owner listed above) State or County License: C;-e CY f 4-1
I f value o.construction Is$2500 or more,a RECORDED Notice of Commencemetlt is required.
............................................................................................ .......... .............
Jan 87 2816 13:37:26 Via Fax -> Vonage Page 883 Of 884
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DESIGNER/ENGINEER. —_--Not Applicable
MORTGAGE COMPANY- � €ot Applicable
Name., dame:
Address: Address:
City: State: City: aState
_.ww.��m.. m.� W,..
Zip: Phone: Zip.: ly.hone:
FEESIMPLE TITLE MOLDER:— got Applicable BCDi11L?ING COMPANY; Not Applicable
Name: ._ m�. .....�.� �. ,W Name: m .
Address, Address:
City: _. City:
Zip: — Phone: ... W i Zip:_ Phone:
6 certify that no work or'instaIIition h'es ccimrnenCed pHar'`to the: f d perrriit: : :.
St.Lucie County makes no representation that is granting a permit will,auth6riae the:perc iitbolder td-build the'subject•structure,
which is in conflict with any applicable Horne 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%hereuy agrcte that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes arid St"•Lucie C®urnty-Arnendmentg.
The following building permit applications are exempt from undergoing a full co.r4'curfency.'kei w:room additidns,
accessory structures,swimming pools,fences,wails,sip.,ns,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 gust be recorded and posted on the j®bsite'• '
before the first inspection. if you intend to obtain financing,consult with lender or an attorney before
commencing work or recording your Notice of Commencement':
- -
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Sign or/LicllH—
olderner/Lessee/Agent
STATE OF FLOi]n ' L
COUNTY OF cc CtUNTY.OF..'
0.,,;;.�• •
The forgoing instrur�nt was acknowledged bfar me The:forgoing instru.menC.was,ackrfowledged before•me.• ,:`:.,::`':;
`this daY-of_ ? ,•20 j. Y t€1is'.�d�i+�:ia{:'�:• "1 t� s9:i- '2tJ ®�t��1`"": '
INarn� of person acknawledgini; (Narne of person acknowledg1ng)
fi 5 �
CL"�,�t a
(Signature of Notary Public-State of Florida') (Signature of Notary Public-State of Florida') '
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SAi3 R l NLA C IC ka �i:,� �dr��ep . S�&�. w��reatia l�d9g��
.Personal) Itnown:,;' ' .::DR Prad'uCe �'� .°� "` perso`na€ty'KnoWn,;_�'�0 ;A ced-Y s�
Type of 1'dentificiTtion Produced ' Tj o of'Iden'tific7tian Pradiic cY' ' *:::'`� °•
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CammIS510n No- $�. �. ".ff4� Pa€� 4�a R .Cammi55iDn N4, �" � TM. �,,: sam,a•. 'h3�fl
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Revised 07/15/201. 1C STA
REVIF,WS FRONT ZONING 'SUPERVISOR PLANSVEGETATION SE:A'TURTLE MANGROVE
COUNTER REVIEW REVICW REVIEW I' `REVIEW REVIEW REVIEW
DATE
COMPLETE
[IN!�rIALs .. . . .i .. .. .
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