HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U l6 / S Permit Number: 5 - d R SS
SCANNED
RECEIVED OCT 16 2015 BY
St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce A 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: / C114
Address: -1
Legal Description,
Commercial _ Residential
Property Tax ID #: 0000 r 06 0 6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Ln 15 PUFF IIL—Cn CC
PUFF
Piping
Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
.F' LE5 E���
CDN�T�TOtt�r
Name , G nn4
Name: r -4�r, < J61"^S on
Address: 2 ?OC, �i r C n �l
Y 'L
Company:
City: r�- /'vr c� State:
Zip Code: 3'� '-I Fax:
Phone Nc..Li -7 Z� L191)� - 'iy 1 )
Address:: 1?61 < y % .9a
City:-P, State:
Zip Code: VJ'l t'� Fax: 7
%
Phone Nc 7�C 6 1 - RD�l -3
E-Mail
f
E-Mail: L Z c ,Ll k O U ( C��,aU"2 ;l pri F�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License 2. F( of
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
IRPLEMN�Of�$$7. I #I'f LAU�/E®'RMAN
7.
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 Counter 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 a jobsite
before the first inspection. If you inte obtain financing, consult with lender or ai attorn efore
commencine work or recordine vo ice of Commencement. A
-Signature of Owner/ Lessee/ACKht
S nature of Contractor/Licerrse Holder
STATE OF FLORIDA
s-
STATE OF FLORI
COUNTY OF L v
COUNTY OF
The for oing instrumen was acknowledged before me
The forgoing instrument was acknowledged before me
Ct
this day of CS c r 20 by
this _L(�_ day of L� 205 by
C�nc�s�-oA�Ri' �o�+�So-t>
C�nc�S4opY��,r '�d�nnSaY�
(Name of person ack owledging)
(Name of person acknowledging)
�r
(Signature of Nota Publi Stateof Florida) —
—(Signature-of Notary Publi State of Florida-)
-P.ersonally_Known VV __ OR Produc trfl t A. 2aL
Sd
J � a=
Personally Known OR ProdUtedTd triJ
P
Type of Identification_
Y ebb\ tP 136JbX
o any pobb° 1 e pe es —
Type of Identification s
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Hev.//ZU14