HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,PPLICABLE INFO MUST BE CO
Date: -zy• / . / -
Planning and Development Services
Building and Code iiegulation Division
2300 Virginia Avenue, Fort Pierce FL 3498Y
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description
Property Tax ID
Site Plan Name:
Project Name: -
Setbacks Fro
Electric
Tofal.Sq: Ft of
Cost of Constr
Name
Address: 5
City: ' 20
Zip Code:
Phone No.
E-Mail:
Fill in fee situ
from the Ow
1V
FOR APPLIICATIONTO BE ACCEPTED �
Permit Number: f)( �•01 (J 0 1 ` q
SCANNED
BY
.St. Lucie County RECEIVED
Building Permit Application APR 10 2015
Commercial Residential
2yl',t-Sbl-1'1(�1-
Back: Right Side: Left Side:
15cal
_ Gas Tank
_ Plumbing
nstruction:
:ion: $ 11 R ®
a
;,_,�, Fax:
L-P- -uLas�
Lot No.
Block No.
permit - c ec a t at app y:
_ Gas Piping _:Shutters _ Windows/Doors
_ Sprinklers _ Generator _ Roof
Sq. Ft of First Floor: _
Utilities: Sewer —Septic
State:F L-
Title Holder on next page (if different
listed above)
Building Height:
Name: Curtis so.Nd ynon S
Company: (',us-r(om Air &S�eW1S )AJC,
Address: lfe l5 S `�l r I (C'eag U re,n Dr
City: Vo T ST La�C « State:
Zip Code: 349-% Fax: q7; 33S 1 �6S
Phone No. 17,2 33,5 ~ 323 2
E-Mail: (Lustr o I
State or County License: Cfl C 0 5 19 /0
if value of construction is2JOTor more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 County 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 followingbuilding
g 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 the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
77
Signature of Owner/ Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORIDA ,,r
COUNTY OF .S / • �+/��'E'�
STATE OF FLORIDA -
COUNTY OF f Iye le
The forgoing instrument was acknowledged before me
this day of AP6 iL 20 IS' by
The forgoing instrument was acknowledged b fore me
this day of /4f OL 20y
.
(Name of person acknowledging)
-04
(Name of person acknowledging)
MIm
y
(Sign re of Nota ubli State of Florida) T
� o
(Sig ture of rotary Publi - State of Florida) z �'
�OR
Personally Known,�OR Produced Identificat
Personally Known Produced Identification IN C3
Type of Identification Produced
Type of Identification Produced
Commission No. jE1', 1Yr3'? (Seal)
Commission No. ��y�3y (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014