HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC. tE 1NF6 MUST BE COMPLETED FOR APPL.ICAMON-rO BE ACCEPTED V
Dater Permit Number:
RECEIVED JUN 2 2 2016 '
Bullftg Permit Application
Planning anc, Development Services
Building and ode Regulation D1vlsPon
2300 Virginic Avenue, Fort Plerce FL 34.982
Phone:(77 462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT A PLICATION FOR: To SeleCt from dropbox, click arrow at the end of line V C
V cs!.•a T'v:.
Legal Descrip
Property Tax p#• Yl Lot No.
Site Plan Name: Block No.
Project Name
Setbacks F nt _ Hack: Right Side: Lift Side:
AIR 9
IS
Sp
r
Additio Wc to e e arms ' underthis permit—check all appy:
HVAC : Gas Tank Gas Piping `Shutters E]Windows/Doors;
I
Electric Plumbing Sprinklers Generator Roof
Total Sq.Ft of on5truction: sq. Ft,of First Floor;
a.
Cost of Constr ction;$ � Utilities: Sewer Septic Building Height:
Name ' ODM ►Name:
Address:A CS Company: ���
City: State: Address: J11
Zip Code: Far.: City: Stat :
Phone Na `��,�Q ._ 3 -- _ Zip Code: �• �- Fax-.172.,q ,�•/(p�l
E-Mail: III Phone NNo. - V9.j
Fill in fee situp Title Holder on next page(if different E-Mails 1_ �D �'!8✓V1
from the Own r listed above) State qr ounty License: 7
If value of const ction is$2500 or more,a RECORbFD Notice of commencement is required. 5
DESIGNER E GINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name; Name: _--
Address: Address:
City: State: City: State:
Zip: 11 Phone: Zip: Phone:
FEE SIMPLE I TLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phare: Zip: Phone:
I certify that int work or installation has commenced prior to the Issuance of a permit.
St Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in can ct with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Pleas consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideratio'of the granting of this requested permit,l do hereby agree that I will,in all respects,perform the work '
in accordance th the approved plans,the Harida Building Codes and St.Lucie County Amendments.
The following b ilding permit applications are exempt from undergoing a full concurrency review:room additions,
accessory stru 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
imp ovemen to your property.A Notice of Commence ent must be recorded and posted on the jobsite
bef a the fl t inspection, If you ntend to obtain financI consult wit lender or an a orney before
com encin din r Notice of Comment • ent.
Slgnat a of e e ee Sig ture o Co tra ce se Hold
i
STAT QF F RI STA 4F ORIDA l w
COU 0 CQU OF
The forgoing in'trument was acknowledged before me The forgoing instru entwas acknowledged before me
thisrday � — 201y this day of zabY
& ... I
Name of pe so iacknowlei g) (Nam pens n acknowledgin
grill of t Public- e o
Statf Florida} gnature of ry Public-StaCe of Florida)
1:114SI 1:
s.:
III
Personally oelta+a� tl 'cation Personally lcowr,�
Type of Ide oduc Type of Ide io' ' '` duce&AALY
•..;
L - ' otar Public•state of Florida'
. °� r?G 11c-S g fnorida Commissio "SS' 1 xpires J(151t�1 o17
Commissi r r �o' � pires8 j Z.Zpil 60� .: GOlnmission#FF OHM
"` mmIsstoR#FF 038392
Revised 07/ 512014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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