HomeMy WebLinkAboutBuilding Permit Application \ I
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ALL APPLi LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: L' Permit Number. 62AZ
REQ
Building Permit Application AUG 112016
Planning an Development Services
Building and ode Regulation Division P�CRt1lil?TiN
2300 Virgini' Avenue,1=ot7 Plerce l=L 34882 Si.Lucie Couni+,
Phone:(77- 462-1553 Fax:(772)462-1578 Commercial , Residential
PERMIT A. PLICATION FOR: To Select from dropbox, Glick arrow at the end of line
Address:
Legal Descrip on:
� l
Property Tax #: `�` Lot No._
dj
Site Plan Na Block No.
Project Name 1
Setbacks Fr nt Back: Right Side: Left Side:
r. nl4a•rs .Yc.. _
ltio I w rk toe e orme un er t is perms —c e a app y: REP
HVAC Gas Tank Gas Piping _Shutters �Windows/Doors,
OElectric IJ Plumbing O'Sprinkle'rs Generator Roof
Total Sq.Ft of onstruction: � �^ - Scl. Ft.of First Floor:
r
Cost of Comm ction:$ �, Utilities: Sewer Ej Septic Building Height:
Name Name:
Address: ✓ Company: `
City. State: - Address:
zip Code: Fax: City: State:
Phone No. Zip Code: t-�q `•Z_ F.X. ` •It o
E-Ma Phone No.
Fiq in fee limp Title Holder on next page(If different E-Mail:
from the own r listed above) � State or County License:
if value of const uction is$2500 or,more,a RECORDED Notice of Cammanci�ment is required.
C
81 4
Now-
DESIGNERIF GINEER: Not ApplicableMORTC�AGI:COMPANY: Not Applicable
Name: game:
Address:_11 Address:
City: Stater City: Stater
Zip: Phone: Zip: Phone:
FEE SIMPLE 7ITLE HOLDER: ,Not Applicable BLINDING COMPANY; Not AppiicWe
Name: Name:
Address: Address:
City: City:
Zip: F Phone: Zip: Phone:
I certify that n work or installation has commenced prior to the issuance of a permit.
St.Lucie Coun makes no represent tion that is granting a permit will authorize the ermlt holder to build the subject structure
which Is In con ct with any applicable dome Owners Association rules,bylaws or andpcovenants that may restrict or prohibit such
structure.Pleas consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideratio of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance m th the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following b ilding permit applications are exempt from undergoing a fVII concurrency review:room additions,
accessory strut 1res,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING T1 OWNER,:Your failure to Record a Notice of Commencement may result in your paying twice for
imp ove I n to your property,A Notice of Commence ent must be recorded and pasted on the jobsite
bef a the fi t inspection. If you intend to obtain financi ,consult wit lender or an a torney before
cam Lancing din r Notice of Commenc . ent.
Signat a of ' e ssee Sig a re o Co tra ce se Hald .
STAT OF F .R C U E O OFORIDA �--/A
COU O _ ,� l.1
The fn going in t lent.was owiedgedpefore me The forgoing Instr ent was alk owledged before me
this�day o r 20.Wby this day of � �'-—'24_�ki�Y
(Name rso acknowle ging) {Name of I n acknowledge
fes,.
Ignature of ry Public-State of Florida) (Si ure of Natar Public-State of Florida j
Personally Kno rl-n�"Q OR Pra�tld4Nlig@tiob_ ersonally Know o ted Identification
Type of Identi
Type of Identift >t" n '� �ScdbhlarY Puf}I!c-Stata of F��rt�� f ti f ted
•�- RALYNNE RUS�EL4
Expires Jul 22,2017 Y
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fission Commission N P p
Commission Ni . '" y ( 11038382 '% aaF�oQ` commissionm Expires Jul 22,2017
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Ptevised 0745/2014
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