HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CC `LETFD FOR APPLICATION TO. BE ACCEPT;
1
Permit Number: � ��' 0(in S'
Date: ���
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1140 Lay
RE �E4`�E®.
Building Pern&�l�'�i`ion
Planning and Development Services JUN fl .5 2015
Building and Code. Regulation Division
PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential .' county, FL
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PERMIT APPLICATION FOR:
Address: l G) 1 5 /&-- C'-t ►'t / � �' �' L. 3 45 61,
Legal Description: i� �' % .�°� '' '�• -
Property Tax ID #: ' Cf/ (9 / 0 o t .�I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: -Left-Side:
itiona worFto"pormeunder PispqrmiRchelFallt
Mechanical Gas Tank — Gas Piping Shutters c_L Windows/Doors
Electric Plumbing I — Sprinklers — Generators Roof
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Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Q� Utilities: — Sewer — Septic Building Height:
Name ` w`�
N /j • AIE7'
Address 1
ompa y:<'� AT!'• E7
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City: f '4 % P%JL '! ►1-2. S�e'`r
Address
Zip Code: Fax: �:
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Cit'�'' ``' V a>, '� State:
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Phone No, 3 S�.. �:
; Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page if dii#fereht.
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:
Name:
Address:
Not Applicable
= _
MORTGAGE COMPANY: _Not Applicable
Name:
`
Address:.
City:
zip: Phone
State:
•
"" ..,. 7
" '
City: State: `
Zip 'Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
UWNtK/ GUNTRAGTOR AFFIOVIT:. 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 priorao 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
commencine work or recording vnur Nntirp of Cnmmpnrpmpnt
Signature of Owner/ L see/Agent
Signature of Contractor/License•Holder
STATE OF FLORA)
STATE OF FLORIDA
COUNTY OFF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this S day of ; 20-C by
j.
this day of 20_ by
(Name of person acknowledgi )
(Name of person acknowledging)
ignature of Notary Public- State of Florida)
(Sign ature"of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally, Known OR Produced Identification
Type of Identification
Type of Identification
Produced C�LQ-t`l11,paS' dVp.�Z6�s • p.,
'Produced
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Commission Na No'tary Public - State-c
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Rev. 7/2014