HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �C,qivNE-0 Permit Number:
" BY
0W Ot. Lucie Coulitv,,
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
RECEIVED
APR 10 2015
Phone: (7,72) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: S�.mi,yoL Rd. F4 P,'cilec , FL
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Legal Description: stt
i
Property TaicID#: ()j)7,- 4�17001-000-9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks lFront Back: Right Side: Left Side:
�Epl►)e6 j rmAi W ah)D Amp pAwtl
unaer tnis Dermit - cnecK aii that a
IIHVAC � L 1 Gas Tank
Electric ❑ Plumbing
Total Sq. Ft of Construction:
Cost of Consttruction: $ /� 07 �0. °O
Gas Piping L 1 Shutters ❑ Windows/Doors
Sprinklers ❑ Generator ❑ Roof
Sq. Ft. of First Floor: _
Utilities: Sewer 11Septic
Name _(_Am'A&A Q Spi6d
Address: _Ac ;t Simb ds RoAd A1.6.
City: KeNm' o,2c State: W A
Zip Code:98oa4 qq 13 /, Fax:
Phone No. %7-2 - y75 - N5t3�
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Building Height:
Name: Gaa,41 R. CawiditoZ
Company: Ccx,,166 C)cc.)a.c ZNc .
Address: 10*:?,1 SaOS�iArr P;)ucj,
City: Y�S f i ►�n� State: FL
Zip Code: Fax: lla- 3B8 -Fill
Phone No. lla- 388 - OS33
E-Mail:
State or County License: SSA}e 1 f C, 0 bwq l
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name: I
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: I Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip:
Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie CouInty 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
WARNINGITO 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 the jobsite
before thelfirst inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature ofOwner/ Agent/ Lessee
STATE OF FLQRIDA
COUNTY OF I N D I A i.l RZSLea
The fo oing�instrurnent was acknowledged before me
this day of APIZZ 1 20 15 by
I
C A C Uia►-oz
(Name, on ackno ledging )
(Signature ofjNoyary Public- State of Florida
re of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF IN DIAPIV�P.('
The forgoing instrume t was acknowledged before me
this day of 20—Liryby
�`► u,�_,✓l roZ
Name of person ackno ledging )
(Signature of Notar'(Ppolic- State of Florida )
Personally Known V OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced I Type of Identification Produced
Commission No, _ — n R— (SealL a m I Commission N
�F^Y Pao, Notary Publie State of Florida +psY goo Nota
=o ry Publla StAto of Plofirda
• I vial Ile
c r. oR M Commission EE104878 �'. ' v
t` Y. v� ,y o My Commleolon C0040M
Revised 07"/ 5 j� Explros 09119/201 s or p. Expires 09119/2,015
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