HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLMD FOR APPLICATION TO HE ACCEPTED
Date, Permit Number: KA" W12,
Building Permit Application
Planning and Development services
8aitding and Code Regulation Division
2300 Virginia Avenue,Fort Fierce FL 34.982
Phone:(772.)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from&opbox, dick arrow at the end of line
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Legal Description:_ G e ' 9 tl Q LZ G� 1( Lt`
Property rax iD M �}s -�E ~0 t�C y(p tot No.
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Site Pian Marne: Block No.
Project Name.. C.-
SetbackS Front Back: Right Side: Left Side;
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Efectricbing �Sprinkfers Generator Roof
Total Sq-Ft of Construction: SCI.Ft-of First Floor-,
Cost of Construction:$ __ Utilities: Sewer Septic Building Height:
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:Name Vl Name: alli
Address-.1�5 1 n j f -` D _ Company. 2. b
City: YY�[ r`�Vi �� L' State:. Address: rO cS U—n
Zip Code: b- EIPSrSS( _ Fax: '7 _ City: t� State:
Phone No_ ci S —q—n'5- Zip Code: „ Fax: q S -227-7
E-mail: ,SS' nr) C. Cat! CPbone No. -5fi G "7-72-5--
Fill
7-72- _Fil1 in fee pie Title Halder on next page(if different E-Mail: C -tn S' Yt,!5U )a CIL)C Y1vtC"�C �r}
from the owner listed above) State or County License:
It value of consu'uetion is$25U£i or mare,a RECoRDEo N*tim of Cormaencemant is required.
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DESIGAIf:R/>rNG{NEER: _,,.,,Not Applici3blez . . .Mp�t�'GAGECQMPANY: `Not Applicable
Address• _ Address:
City: State: City. State:
Zip. Phone: Zip: Phone--
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: i Zip: Phone:
1 -
1 certify that no work or installation has commenced prior to the issuance of a permit
St.Lucie County make$no representation that is granting appermit will authorize the permit holder to build the subject structure
which Is in conflict with any applicable Home Owners Association rules,bylaws or andcovenantsthat may restrict or prohibit such
structure.Please consult with your Nome 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 l will,in all respects perform the work
in accordance with the approved plans,the Florida Building Codes and 5t-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,sc men rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may resuk 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 u Intend to obtain financing,consult with lender or an attorney before
commencing k or reRdM&your Notice of Commencement.
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`sign - erf see/Agent � rbJ� Signat� o Tactor Lic a Holders
STA ORIDA ST F LDRIDA
CD QF �i:C�i�, ... CO OF 1>.374 %CU
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I day ofina ccr— 2d �by this day of r3—6 20�by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of N&diY P" Iic-State of Florida) I (Signature of keifa uublic-State of Florida)
Personally Known �OR Produced ldentfiication Personally Known ✓ OR Produced ldentificatlon
Type of Identification Produced Type of Identification Produced,
Commission No. l F: f9eg7-7"s (seal) Commission No. (Seal)
,,�;,*.'�"'•4 Gail Gait H. Gender
Revised 07/15/201
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
I N n-IALS