HomeMy WebLinkAboutPermit - Perez - 9455 Windrift Cir SLC ALL APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Planning and Deveiapment5ervices Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34-982
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial
Residential t.�
PERMIT APPLICATION FOR:
Address: ICS- A
Legal description:
Property Tax ID#: ` N 0 - Sb 0 �
Site Plan Name: Lot No.--L—`_
Project Name: Block No.
Setbacks Front Back: Right Side:
� Left Side:
AETAI.I .D osRlrotu
oNSTIu�O
wor to e e orme un ert ispermit-c eci a " -
pp y:
_HVAC Gas Tank ❑Gas Piping Shutters
windows/Doors
Electric Plumbing Sprinklers G
LJ enerator � Roof
Total Sq. Ft of Construction;
S Ft.of First Floor:
Cost of Construction:$ � �a
Utilities- Sewer OSiptic Building Height:
AC
Name
Name:
Address: -
Company: � r
City: ; CA" -E'__
State:j6. Address:
Zip Code:_, r 'J_t Fax: '^
Phone No- �., � - � + City: r �� _ State:F1.
Zip Code: j, Fa
J'
E-M a I: � �
Phone No. �� •�.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above)
State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address; Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: _L_,Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first ins coon, If you intend to obtain financing, consult withlender or an attorney before
commencin gpeecording your Notice of Commencement.
s
re of Owner/Lessee/Agent ture of Contractor/License Holder
TATE OF FLO STATE OF FLORW�. 1
COUNTY OF � L-, (,t`[ COUNTY OF 4LkC4 0—
The V'ng inst ent was ack owledged efo e me Thefor ping inst ent was cknowledg �d bbefore me
thisday of ,�j�s� �. thi�day of 2Q [.by
(Name of person acknowledging) (Name of person acknowledging)-
2} r�y"•"L
(5i9SASMioi�it�t�ry ItHO to of Florida` SP�,,..,•.b' �iy (Signature of Notary Public-State of Florida) o!!
Cq �►11N111111fp f
�tssrpy•.�' S/�►BRIN CK ION S° ,?,RINA( ����s�i
Personally Known OR Produced ' Y_ personally Known R Produced Idt`tifi�agjl• «-,�p ���
Type of Identification Produced w m, �pe of Identification Produced .AP U4 �f
Commission No. FF l3 #FF195337 11Zcommission No. �. Aal) �•� tee:
f 9 NI*d thus
'95337
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Revised 07/15/2014 lllNllill«���� j�%�lf�STA
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