HomeMy WebLinkAboutBuilding Permit Application 12/21/2016 09:15 7724626448 SLC CODE COMP PAGE 02/03
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AU APPLICABLE INFO MUST BE COMPIETED FOR APPLICATION TO BE ACCEIri'ED l 2 J/
Date: _ - -- � Perm-it Numlaer:_
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Building Permit Applicat on
Plennrng anpl t>eve/opmerrt SeruJceb
Bull&g and Cnde llegufWaji Dlvkfan
23W VirgirrioAwnue,Fart Pierce FL 34982
Phone..(772)462-9553 Fax:(77Z)462-1578 Commercial.-�_ ReSidentlil
PERMIT APPLICATION FOR,,To Selact-from dropbox, click bore•i
PROPOSED INPROVEMENT
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Address:
Legal Description: df
PropeM Tax ID#: 450-41)� 1 D600� �' Lox No.,
Site Plan Name: �_ J, Block No.
Project Name:
Setbacks Front. Back: Right Side: Left SidIe- i
DETAILED DESCRIPTION OF
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CONSTRUCTION INFORMATION:
itiona wvr to rme un err is perm —c ec a appy:
HVAC G Tank ❑Gas Piping _Shutters HWindowWDoors
�J;kectric Plumbing ❑Sprinklers E l Generator Roof
Total Sq_Ft of Construction: Sq.Pt.of First Floor: _
Cost of Construction: I
Utilities:liSawarliSeptic j Building Height.-
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OWNER/ EE: CONTRACT l
Namig � Name: - -
Add > -Or2 c--� Company:
City, 91" �State4 Address. -7&-a
Zip Code: Fax' City: Sf
Phone No. ZIP Code: Fax:_
E-Niall -- _� Phone No. P ejZ1g1 --
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Fail M fee simple TitJe Holder on nod page(if dlfrrerent E-Mail-
from the Oviner Iksted above) State or County License: % r.� 7
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IF value of aonstrMWar is$2=0 or more,a RECOROW Notice of Commencement is required.:',
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SLC CODE COMP �` PAGE 03/03
12/21/2016 09:15 7724626448 | /
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SUPPLEMENTAL 00NMUCTION LIEN LAW INFORMATION:
�Gt Applicable
Name: Name:
Address:_ Address:
Zip: Phone: Zip-—Phone:
FEE SIMPLE TrrLE HOLDER: 75 Applicable
Not Applicable BONDING COMPANY;
Name: Name:
Address; Add"-
City: city.
Zip: PhQne: Zip-, Ohnne*
OWNER/ NTRACrOR AFFIVVIT."Applicmion is hereby Made to obtain a permlt6 do the'*' ojt and instafttion an Indicated.
r certify that nG work or Installation has commertced priorta the issuance of a permit.
w hIsIn; 1%V1,1, 1,anjappifc2 le horne Owners Assoc ation ruie�, ylavaor a covenants that mav'rostrictorpmhIbit such
loge =t wr th y9ur Home Owners A=dation and revjbw your doe-Mor any mstrictions which may apply,
in consIderation of the jP nting of this requested parrrtit,I do hereby agree that I will,in all respacis,perform the work
in accordance with the approved plans,zhe Florida building Codes and St.Lucie County Ahteftdmclil�-
The following building permit applications are exempt from undergoing a full
.foncurrency Wow.room additions,
accessory structures,swImming pools,fences,walls,signs,screen=ml and sorV mies to another non-nesidential uft
WARNING 1*0 OWNER:Your ftifure to Record a"Ice*f Common ent may It 116 youir paying tvAce for
im ovements to your roperty�A Notice of Commencement mu ke co nd posted on the jobsite
commencing Work or recording your Nati ofComm cement.
Signature of Owner/Agent/Lessee Sigmaure of 0 wo—a
STATE OF FLORIDA STATE OF
COUNTY OF- COUNTY
this_day or 20LJ by this day 26ED by A
(Name of pe;7n acknowledging) fWairve—of
(.5ignature of Notary PubFic-State of Florida) N P lic-State 90iorida
Personally Known_OR Produced Identification PeronalIV Knom 0111?ro�ucedldantlfl. o
Type of Iden0ficatlort Produced, Type of Identtlimbo r6duced1, --
ALL
Clary pu6114-State d(flarldua
�Wres Jul 31,D2911 7
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER RFIAEW REVIEW REVIM REVIEW �wliiw REVIEW
DATE
RECEIVED
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