HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Datli: , a5 Permit Number: ���1JdrP p3
SCANNED
�irervastonRECEIVED
"1c�i'r����?nit Applicatio JUL 24 2015
Planning and Development Services Bu
Buildng and Code Regulation Division
ST. Lucie County, Permitting
2300I Virginia Avenue, Fort Pierce FL 34982
Phoiie: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PER 1M IT APPLICATION FOR: Roof - M-t}q l
Addre�ss: gpimlinc,
El
Legal Description:" 4 ;
1 -
1
Prope6 Tax ID #: 0UO3•" 000- 1 Lot No. C
Site PIS n Name: m oill Block No.. A
/-�WAm
Project Name:
Setbacks Front Back: Right Side: Left Side:
ti
it,,
iti i na workto e e orme under this permit- c ec a apply:
Gas Tank ❑Gas Piping Shutters I] Windows/Doors
_
Electric Plumbing Sprinklers E Generator ® Roof Roof pitch
q
Total S' Ft of Construction: 5 tj1 7— S . Ft. of First Floor:
Cost of�Construction: $ � , 0,00- O Q Utilities:'n Sewer Septic Building Height: {y
r
Name Q _
Name: r I-Z
Addi 1'1 03. Amu 0Cj)(�. \—Y"% _
Company:
l:
City: t State: 1
A ss: a �D Sr .
Zip Co ile-_ '-Acl%_j ,Fax: —
City: q_4 X\06 A State:
Phone f�I o. `l%�D 3y,1- G %U
Zip Code r-i q5 Fax:
E-Mail:IlI�l
Phone No -'1 n'&_ -Ao%
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from till Owner listed above)
State or County License:C_C_ -,JU loa D
If value of
�I
construction is $2500 or more, a RECORDED Notice of Commencement is required.
l�
SIGNER/ENGINEER: Not Applicable
11
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
Ci'y:
Zi
State:
Phone
City: State:
Zip: Phone:
Fit
SIMPLE TITLE HOLDER: �( Not Applicable
BONDING COMPANY: �( Not Applicable
Name:
Ad1dress:
Name:
Address:
City:
City:
Phone:
Zip: Phone:
Zips:
ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
y that no work or installation has commenced prior to the issuance of a permit.
ie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
ire. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
;ideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
rdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
lowing building permit applications are exempt from undergoing a full concurrency review: room additions,
:)ry structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
VING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
tvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
e the first inspection. If you intend to obtain financing, consult with lender or an attorney before
fencing work or recording your Notice of Commencement.
it
Sign°i
re of Owner/ Lessee/Contractor as Agent for Owner
Sign ure of Con trac or icens older
STA'ITE
COUNTY
OF FLORID
OF �-_.A.0—A'L,
STATE OF FLORID '
�_LkC1-L-
COUNTY OF-
The forgoing
jl/
instrument was acknowledged before me
The forgoing instrument was acknowledge before me
this
day of 20� by
this � day of y-1 20l' by
V c vu
.1,1 i n �:s &C �5�� �r1 <'
Name of person making statement
Name of person making statement
Personally
Known N OR Produced Identification
Personally Known OR Produced Identification
Type'
of Identification
Type of Identification
Produced
Produced
6
(Sigature of Notary Public- State of I rida)
(Sign ure of Notary Public- State of Flori )
MARK KEN
Z�Y PU6W"O'
Com is1 (Seal)
Expires September 19, 21
�*%Y PUB MARK KENNY
CoSti N Seal)
rExpires September 19,2021
VO Bonded Tluu Budget Notary Services
9lFOF �o��c Banded Ttw Budget Hotel SeryWs
REV+�WS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE)
RECEIVED
DATEJI
COM ,,LETED
,
Rev. 8/2117