HomeMy WebLinkAboutBuilding Permit ApplicationI�
All APPILICABLE INFO MUST BE COIF' ' TED FOR
3
Date: tok, .�
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 3 W o
Legal Description: _
TO BE ACCEPTEL,
Permit Number:
RECEIVE
Building Permit Application JUN 3 0 2015
Commercial Residential ✓
Boa- oql< Av6 FP 5g9br
PropertyTax ID #: 3i46LI 712 000 L — 000 Lot No._
Site Plan Name: IM-tLv q-( Block No.
Project Name: iri e_LV i Ili
Setbacks Front A' I Back: 3 6-L.7) Right Side: LISt 6 i Left Side: I I rl
AC1amonal worK TD De perrormeo under Tnis permlT — cnec
�IVlechanicai. ,�.: Gas.Tank
Electric ,t —Plumbing —Sprinklers
Total Sq., Ft of Construction: 51.B,�O
an tnat:appry:
*1 _.Shutters,. �_ Windows%R:ogrs;ti
Generator Roof
Sq.-Ft of'First Floor:
Cost of Con 'struetion: $ 14,56, 3!o B Utilities: — Sewer — Septic Building Height:
301
W
Name 14cL oaLd
Name4h,c[1.(_L Dr r,&, w5.a
Address: -'1301 C' eL►io� Cr uLctK a
Company: DT47cc,es43 �vrC
City: V:�V_ State: r--,L
Address: 219'1ry komy_Sbi•i e prnr I�Ar
Zip Code: Fax:
City: f — Pi`e_a--C State: r-.(—
Phone No. 2a -33 D.. f l�
Zip Code: 2Y -1 L Fax:772, q6S 7173
E-Mail:
Phone No.7'77- 2-01 -2117
Fill in fee simple Title Holder on next page ( if different
E-Mail: CQ v? c & ao L , ea
from the Owner listed above)
State or County License: 913
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:. Clink avp,-t m e_;gd_c0
Address: Rpo
City: -f-- T- P;e?-c� State:,Yc(—
Zip: •_;U42'2_ Phone: 772 Y60 `7`751
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordinglyour Notice of Commencement.
Signature of Owner/ Agent/ Lessee
STATE OF Fl.
COUNTY OF
The f rgoing inst as a knowled€
this day of 20
ame of person acknowledging)
Signature of Contractor/License Holder
STATE OF FLORID
COUNTY OF
Xpit a
The ogomg i
zM��
thiday
dgx
(Signatur o Notary Public- State 6T Florid )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
was acknowledge) before me
ie2 - 2 J %y
(Name of person acknowledging
otary Pubric- State
Personally Known OR Produced
Type of Identification Produced
Commission No.
a
a
(Sealll _ 8;N
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