HomeMy WebLinkAboutBuilding Permit Application ' I
ALL APPLIC LEJNFO MU TBE COIVIPL D FOR APPLICATION TO BE ACCEPTED
Date: \� . �1
Permit Number:
RECD`,' B "12 0 2015
BOdi ft Permit Application
Planning an Develapmenr Services
Building and Code Regulation DIVWon 1
23001/lrginl Avenue, Fort Plerce PL 34982
Phone;(77 462-x,553 Fax:(772)462-15 Commercial
Residential
PERMIT A PLICATION FOR: To Select*M dropbox, click arrow at the end of Ilrle�ot•�� ���..�$ •
Address: • -�
Legal Descrip on:
PropQrty Tax #•
Site Plan Na -- Lot No:.—
' Block No_
Project Name - —
Setbacks F nt Back: Right Side:
Left Side:
i lonaI T F ;•:.�,zfs:;N.,:f.r�`,
w to e e orme un er is peapp Y:
OHVAC Gas Tank []Gas Piping Shutters Windows Doo •
/ rs
Fliectric UPiumbing Sprinklers Generator L3 Roof
Total Sq. (t of {onstructlon; _ 5 .Ft.of First Floor:
Cost of Constr ction:$ Utilities:T]Sewer Septic Building Height:
Name ,. ••t�n,��°�,.�::;� :
Nani
Address: V Company:
City:
State: Address:
Zip Code: Fax: City: L'-
5tat�:
Phone Na. �
Zip Code.-:5AAI
YL
E-Mail: Phone No,
Fill in fee limp e Title Holder on next page(if different E-M211X. CO yll
from the Owni r listed above) State or Cdunty License:
If value oif const i action is$2500 or more,a RIWORIDED Notice of Commencement is required.
ii
A, '55
.:Nay?
DESIGN IRI i E GIEER: Not Applicable MORTGAGE COMi?ANY• Not Applicable
Name:' ii Name:
Address; I Address:
City- State-
State, City:
Zip' Phone: Zip: Phone:
FEE SIMPLE LE HOLDER: � Not Applicable BONDING COMPANY: _..,Not Appiic4ible '
Name: Name.
Address: Address:
City: li City:
Zip: Phone: Zip: Phone:
I certify that ric ork or installation has commenced prior to the Issuance of a permit.
St.lucle Count , akes no re resent tion that is ranting a ermit will authorize the permit holder to build the subject structure
which is in can with any applicable Horne Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Pleas L consult with your home Owners Association and review your deed for any restrictions which may apply. .
In consideratio bf the granting of this requested permit,i do hereby agree that i will,in all respects,perform the work
in accordance v h the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following ti ding permit applications are exempt from undergoing a full concurrency review:room additions,
accessory struc 'res,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING T OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvemen . to your property.A Notice of Commenceent must be recorded and posted on the jobsite
bef a the fe inspection. If you'ptend to obtain finance ,consult wit tender or an attorney before
com encin `' rdin r Notice.of Commenc • ent.
II
Signat a of s ee Sig re o co tra ce se.Hold
0
STAT OF f Its STA E Of O
COU O a COU T Of
The forgoing irument was acknowledged before me The forgoing Instrument was acknowledged before me
this day o 1 20!L4y this. __day of .20—toy
i.
(Name of pe rs lacknowledFi g) (Name of pers n cknowledging)
.i
gnature Lary Public-Sta f Florida} a�gnature of No Public-State.•of Florida)
Personally K iZ,.# _, Personally KnoR Prod ffA40# gft#fiEn
'type of Iden ,{f�ucedJERALYMType of identific I �d ���}�,s�:,«amort•
* e = Notary Public-State of Florida ` t:yP�ras ju122.2017
Commisslon " *~ xik2,2017 Commission No. a d &suidn-V 03s�82 z
mmission FF 096392
Revised 071 5/2014
REVIEWS FRONT ZONING SUPERVISOR Pi:ANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW - REVIEW IREVIEW REVIEW
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