HomeMy WebLinkAboutBuilding Permit Application •
BE COMPLETED POR APPILICATION To BE ACCEPTED
�ermit Number:
-7
t-4-1
RECEIVED
Buildhi
•
ul�Development services g Permit AppliCation
0 s! Ode Regiiiatiol?DIvisioll DEC 2 112016
ii E'Avenijeport plerce FL 34982 PERMITTING
4 St. Lucie C unty
62-1553 Fax: (772)462-1578
CoMme'rcia1v0!NLResidential
TLICATION FOR: To gel
r
H,
fir,. 1A,
'ct frOM driii ox, click arrow at the e )f line
nd
Rlii
l�
Y� q 1,T?
Address,
Leg Descrip,-j on',, I`
Property T -1
ax #:
Site Plan Nam .
Lot
Project Name
Slock No.
Setbacks F nt
Back: Right Side:
L6
WRI
Side
D
TOLE,frffil
"R
1; 01 Zij _,
;4ii qgj�i V
Additio i"2L
ed Under this krmi'"
t--check�aiii iippqw
HVAC
Gas Tank Gas Piping
El Plumbing Shutters WindOWS/Doors
05prinklers FIGenerator Roof
TOta I Sqof •, F
oor:
Cost of Cot Instruction:
S Ft of First Flns�lfl,ion:$ Sewer Septic Building Height-
1" ' 7
g
14M-orf'AE
w
J R",
v,
22!"l
U±AMP
1V
M
Zip Code;
Phone No.
Ulff
i
DESICNEitj, INEER: Not Applicable M4ttTCAGI:C(]MI'ANY. Not Applicable
Dame; .i` Name:
Address: Address:
City' State: City: State: --
Zip: Phone: Zip: Phone:
FEE SIMPLE TLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name: -
Address: Address.•
City: City:•_.,
Zip: is phone: Zip: - _ —Phone:
I certify that n 'ork or installation has commenced prior to the issuance of a permit.
st.Lucie Count 'akes no representation that is granting a permit iiii authorize the permit holder to build the subject structure
Wis in con �.with any applicable Home owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Pleas onsult with your Nome Owners Association and review your deed for any restrictions which may apply•
in consideratio i f the granting of this requested permit,l do hereby agree that I will,in all respects,perform the work
In accordance the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following b ;ping permit applications are exempt from undergaing a foil concurrency review:room additions,
accessory struc r0s,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING T PWNER: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
be f e the fl ;inspection. If you ntend to obtain financf ,consult wit lender or an attorney before
corn encin rdin r Notice of Cpmmencetnent. —
Signat•re of e' see Sig a ure o Co tra ce 5e Hold
STO STA E OF OR
AT 0lDA W COU T
Coll III .
The forgoing ins nt w s acknowledged before me
The for ging in irument w s acknowie2aedbebfYre me this day of�� zoby
til is-Zt,day o��
` icnowled Ing) (Name o rsan acknowle ging)
(Na f per o ;a
e of Florida
( ' nature of N iy Public, tate of Flor a
{S ature of No ry Public-Stat i
� ersonaliy Known
ersonaily Kno � P'o c d Identification�._..,
i OR Produced Identification
Type of Identification odGrd•
SULL
Type of identifl ( Ian Produced "` "�'v JLpALYNNF RUe of.Commission No. tv.r�'" State of FloridaFi
' Sea :� L•�,r ',9y • Expires Jul 22,2017
Commission N tio-aY pv@., JERALYNIIE riUSSELL t t .;r f Curtu•R sston ' F
Notary Public-state at norida r M
x = My Cr,R;;r.Expires 3u122,2017
•&^c
Revised 07/ Oommissi4n FF 038392
#
lVE rTATIQN SEATURTLE iViAIVG OVEW
RONT 20NiNG SUPERVISOR PIANS REVIEW REVIEW REVIEW
REVIEWS 4 FOUNTER REVIEW RI VIEW REVIEW
PATE'
COMPLETE L �:
1:
iNiTIALS i I: