HomeMy WebLinkAboutBUILDING PERMIT APPLICATION7
All APPLICABLE INFO MUST BE coN..-.-rED FOR APPLICATION TO BE ACCEPTEr
Date: PermitNumber: /,<192�01)sy
SCA-MYED
BY RECEIVED
JUL 2 2015
Building Perm'it Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT PPLICATION FOR:
11.P,R0fi@aE
Address: '2DO
05 t1QV
Legal Description:
PropertyTax ID #: otw sq a�L -So,;� ono C:00 -a:, Lot No.
Site Plan Name: Ce�5n Cy-L,- Block No.
Project Name: 00,bqt
Setbacks Front t;90) Back: 910 RightSide: J r�6' Left Side: A2�96)
M�� @F WOM
COX-
ACIClitional work to ge-peTrormen-UrMer t t - c M=ft-tn-a t-a p—p i y:
Mechanical �'&9'T-�nk,`- t "Gas . Piping _Shutters -Wihdows/Poors
Electric. Plumbing Sprinklers Generator Roof
Tota[Sq.-Ft.of Construciion:1 Sq. Ft. -of First,Floor:
Cost of Construction: $ Utilities: Sewer Building Height:
_Septic
W�FN-E-RATLE-S—SE
R AMTO
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Name �?Y6 OS
Name: C � &,ii
Address:-
Company: r-S /'�. Cz-xiaS'
City: q-y-State:
Address:
City: Kv,,v State:-f-t-
Zip Code: ��O& 5; Fax: C�P-/50�
Phone No.12,2-X0 - 30-29�
Zip Code. Fax:
E-Mail:
PhoneNo
Fill in fee simple Title Holder on next page (if different
E-Mail
cA e-le "I
State or County License_ 1-4��
from the Owner listed above)
is required.
�f value of construction is 2500 or more, a RECORDED Notice of Commencement
11.
DESIGNER/ENGINEER:'--' Not Applicable
Name:
Addr�SS:_1;W_ e.--( —NV-,Rtk
City: ::rjk�5 State:
Zip: Phone
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: —Not Applicable
Name: Name:
Address: Address:
City: C,1 y:
Zip: Phone: 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 th - e 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 und ' ergoing a full concurrency review: r6om 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 Notic'e 6f Coirnmencement may result in your paying twice for
improvements to yourProp * A Notice of Commencement must be recorded and posted on the jobsite
before the first inspecti9prOvou intend to obtain financing, consult with len n attorney before
commencing work oi�KK our N_Dticerof Commencement. 1� %
Signatur—eAl�evvner/ Lessee/Agent
Sig&ufg-of Contractor/ffe-rise Holder
STATE OF FLOR"
STATE,OF FLORM
COUNTY OFm
COUNTY OF 1 16
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(Signature of tary - 1blic- State15f FlorW
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Personally Known OR Produced Identifi
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Type of Identificat
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Commission No. (Seal)
Commission?o (Seal)
REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
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COUNTER
REVIEW
)REVIEW
RE�
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETE1
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