HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONa N
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:s�/�I/S� Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
RECEI1. 7 SEP 172015 SCANNED
BY
Building Permit Application St. Lucie County
Commercial Residential
PERMIT APPLICATION FOR: (3- QS III
Address: hDSS/ 4 /l,
Legal Description: R�ar,i (���/ /� �G2✓1 — S/C//�., l [ 07 /
Property Tax ID #: V4F11- SvG-DooQ - U6U-O Lot No._�
Site Plan Name: lL4 /a SSi /. e- 1. Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical
Electric
,)�GasTank
_ Plumbing
Total Sq. Ft of Construction:
1/ Gas. Piping
_ Sprinklers
Shutters
_ Generator
Sq. Ft. of First Floor:
.,i
Windows/Doors
Roof
Cost of Construction: $ - IrUG. Gli__ _ _ __ _ Utilities: —Sewer _ Septic Building Helght:
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Name._ Gti, / LLG
Name-- `AnrH /jcoc%.
Address:_/4/5 eyc✓ kiv*. fr•, /
City: 2-�,,-t Stater[
ZIPCode: 3VYYi/ Fax:
Phone No. ')7 2 l 3 3 075/e/
Company:_Q~f,1 Ga c
Address: -330/ Ole4,,6, /%e
City: /2rT 101-etew State:
Zip Code: 3 �e9 gR07 Fax: 2 2 z -
Phone.No. 7/a .633 •07f/6
E-Mail:,,n, . �, �� oas.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mai1: i , 06,1-2
State or County License: 5
it value of construction is 2500 or more,a RECORDED Notice. of Commencement is required.
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DESIGNER/ENGINEER:
Name:
_ NotApplicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone:.
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
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 Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflictwith any applicable Home Owners Association rules, bylaws or.ano covenantsthat 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 anothernon-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
ImpravAmentsto your property. A Notice of Commencement must be recorded.and posted on the jobsite
fore thV firo4 inspection. If you intend to obtain finan ' ,,c sult(Gitk lender or an attorney before
Lessee
The forgoing instrument was cknowledged before me
this day of�_ 20_LJ
/t /4Ala_'/ Mi10'-2
(Name acknowledgln )
(Signature of Notary P blic- ate of Florida)
r
_. _. - s r L&-c,a
The forgoing instrument was acknowledged before me
this JZ day of , i Se. 20—ZSly
e of Identification P x:
Type C9MMI8�,19N a sao 80
Type of Identifiw0TIRE
MT GIrMMhIJIVry N ccc vow
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17tPIRES July 18.201
I
Commission No. C
E Juty ta, 2016
a BNq�ldl
Commission No. /Zears
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