HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /L S IS -
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (172) 462-1SS3 Fax: (772).462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
Permit Number:
SCANNED
BY
St. Lucie County RECEIVED
Building Permit Application
NOV - 5 2015
Commercial Residential
Property?ax lD #: lVc99
-
3 Ya, C900/ —600- 4r
Lot No.
Site Plan Name: ST
4'el-,
6Nt, y
Block No.
Project Name:
Setbacks Front /G Back: /o RightSide: /a LeftSide: is
_Mechanical XGasTank-,XGasPiping
Electric _Plumbing _Sprinklers
Total Sq. Ft of. Construction:
_Shutters Windows/Doors
_ Generator _ Roof
Sq. Ft. of. First Floor.
Utilities:
City: . % Ozz t- i State: r l
Zip Cade: 3V YF- — Fax:
Phone No. 7;) 2•- - y68 - /SS3
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Company: 9,�?Fpr 6.4 t
Address: _ 330�/� Ol e,2 ,h, e4f
City: /7ip'r Al ete i Stater/
Zip Code: 3?9J06? Fax: 77L-/1a3=�YY�
Phone No. 779 -633 •07f/G
E-Mail: ,n,1l, ,r2,49 90a o
State or County License: 52 —
is'2500 or more, a RECORDED Notice of Commencement Is required.
n ppMiiNl G�015fi U(sfr{ 1�1N" 1
DESIGNER/ENGINEER: _ Not Applicable
Name:
(,9 t` f+cdl Y.M -['1 �fS: n'.ixra A } F A J Y" f T\ '3
O ' dTipNsNb�z;;�`„s SFr Yapr
RM , I � � , p ,
:ti` t4i- u .d�,
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _
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 County makes no representation that is granting a permit ill authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rues, 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
TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
?nts to your property. A Notice of Commencement must be recorded and posted on the jobsite
first mspection. If you intend to obtain finanpWig-c-oirisult@Rklencler or an attorney before
STATE OF'FWRIDA
COUNTYOF S'T
The for oing instrument was ac5knowledged before me
this, day of A ld, upon Ll[I .20 /_iby
Type of Identification
Commission No.
The forgoing instrument was acknowledged before me
this R day of l0elL1pm J� . 20Sby
No.
REVIEWS I COUNTER i REVIEW I SUPERVISOR REVIEW I REVIEW I" EVIEWON I SE EVUR`NTLE I MREV EWVE