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ALL APPLICABI INFO PAUST BE COMPLETED FOR APPLICATION-TO BE ACCEPTED
Date: Permit Number: 1
x
Building Permit Application.
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fon:Pierce FL 34382
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential V/
PERMIT APPLICATION FOR: To Select from dropbox,click arrow at the.end of line.
.,PROPOSED l�MPROVEMENT'LOCATION: ,
Address:
Legal Description: M Q r rl\N{cr�tAk Y FAY, 4 1 n+ ci
Property Tax ID#; 2420^ ()'2_- fa()-(JQQ-Z Lot No._ 9_
Site Plan Name:- 2-'717- `7 2 Block No. 4
Project Na me
Setbacks Front Back: Al/k Right Sider left Side:_Q _
.._._ . .
;DETAILED DESCRIPTION OF WORK:; ,
vWr wait roE V\,Z-\ 'f00- �rCXkk WQD& c� *o cue
a�c re roo-�,wt 51�tv,�tes. 31/ 49 1+C jl
CONSTRUCTION INFORMATION
Additional work oe e orme under this permit-checka appy:
0HVAC 13GasTank ❑Gas Piping _Shutters ❑ ndows/Doors
❑Electric E]Plumbing- ❑Sprinklers ❑Generator Roof
Total Sq.Ft of Construction:.2-SOC S .Ft.of First Floor:
Cost of Construction:$ In, CO Utilities: Sewer❑Sep WA Building Height::
CONTRACTOR
Name Name:
Address:a$I2_ Company. (-Qltly-,t
City: State:9- Address: Po E)m 1
Zip Code: Fax N city: State:
Phone.No. 1ti11A Zip Code: 349:7'1 Fax•.
E-Mail- 11ll^ _ Phone No.. 7
Fill in fee simple Title Holder on next page(if different E-Mail Ca I I Ip
from the owner listed above) State or County license:
If value o construction is$250o or more,a RECORDED Notice of Cammencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.:
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:
1 certify that no work or.installation has commenced prior to the issuance of a permit.
wh ch is inoconflimaw,h anrepresentation
applicab a HomeaOwners tAsssociationirules,authorize
ylaws or and covenants that may the subject
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,Ido 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 cont ncy revi w:.roo ions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and essory uses to thetnon-re 'dentia)use
WARNING TO OWNER:Your failure to Record a Notice of Com ncement ma ult In your pay ng twice for
improvements to your property.A Notice of Commencem t must be r d and p ed n the jobsite
before the first inspection.If.you:intend to obtain finan ' g,consult le der or oey before
commencin,g work or recording our Notice of Comm cement.
-Y 7. s
SjgVWture of Con dor nse Holder
-i_Wambw
STATE OF FLORIDA I STATE OF FLORIDA ^
COUNTY Of x"77 U Lkj COUNTY OF �, I e–
The forgoing instrupnqnt was acknowledged before me The forgoing instrument was acknowledged before me
thii '�dayof 20 f�by this_Ldayof O�[ u� 20 ��o by
U 1 60.—
(Name of person acknowledging) (Name of person ackn 1 ging)
�LJIA A
lla
(signatu f Notary 10
blit-State of Florida). ( ,gnaVre Public-State of FloridaPersonally Known ✓ ORProduced Identification Personnown OR Produced ntification�
Type of identification Produced Type of Identification ProducedVcl 2.1 I _ql)473b.
is
F('d 1 t�G I JUDY A.DAVIS Commission No.
Commission No, )NOTARY PUI3L1 EY D FRENCH
STATE OF -L IDA
`^Rv PLO`s Y Nota, Public-State of Florid
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Comm#FF017462 "-' • °'e Y
Revised 07/15/2014. Expires 6/3/2017 ti =rp; Commission ;x FF 069924
i i,,,i OF FIV1A d
( Bonded Through National Notary As
REVIEWS FRONT ZONING. SUPERVISOR PLANSVEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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