HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE CPMP€ETED FOR APP CATION TO BE ACCEPTED
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Building Permit Application FEB 2 5 20%
Planning and Development Services P E=N N1 f-1-I•I N G
Building and Code Regulatran Division' Si. Lucie County, FL
23M Virginia Avenue,Fort Piero Fin 34982
Phone:(772)452-1553 Pax:(77z)45Z-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropOox, click arrow at the end of line
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Address: C6d
Legal Description: I-t f`4 i) 90 I e—S
Property Tax 169- 1 —00q—o 0 Lot No. _
Site Plant Name: Block No.
Project Name: W eg
Setbacks Front Back: Right Side: Left Side:
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Adic[Wnal work to Ma[Wtormed under trus permit—_check.al apia Y1
HVAC Gas Tank ❑Gas piping _Shutters Windows/Doors
Eiectrit Plumbing05prinkiers Generator, Q Roef
Total 5q.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ Utilities=Osewer O Septic Building Height- --
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Name dame:
Address- 0Com
pany:alf .�L—_�Y`
City: ( 1 State:(, , Add.
Zip Code: *;)fl G?1 Fax: •-q l f� Cityi r State:`
Phone No. Zip Cade:-",464r?q— _ Fax- ',-2jq5—qr?Z'7
E-Mail: Gtr o Phone No.
Fill in fe simple Title iN4fder on next page(if different E-Mail: �i
€nom the[owner listed above) State or C my license:
if value of construcoon is$2540 ar more,a RECORDED Naz€te of Commeneemetat is required_
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DESIGNER/lENGINEER: _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: I 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 represenritation that is granting a permit will authorize the permit holder to build the subject structure
which Is in conflict with any applicaE�le Home Owners AssocWlon rules,bylaws or and covenants that 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 I will,in all respects,perforin the work
in accordance with the approved pians,the Fiorlda Building codes and St.Lucie County Amendments_
The following building permit applications are exempt from+dergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wails,signs,—teen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Not' of Commencement may result in your paying twice for
Improvements to your property.A Notice of Com encement roust be recorded and posted on the jobsite
before the first inspectici .if u intend to obtain financing,consult with lender or an attorney before
Cornmen4in k or recopdifir,your Notice of Commencement.
Sig erJ eJagent GS/ i'rf� Signal ractdrjli Haider � r5rn
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day o#_ i�� , 20 Jby this day off d ,20 1(a by
C,d,,1 � L7L Cede/ / � f��l -
(Name of person acknowledging) (Name of person acknowledging)
(signature of N ry P'(6lir,state of Florida) (Signature of tsidwWPuu6Iic State of Florida)
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of identification Produced Type of identification Produced
Commission No. (Seal) Commission No.
1TU1• Gail Gail H. GerWe
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