HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Lk ati 5 Permit Number:
RECE1"'.7D APR 241015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)452-1578 Commercial Residential
PERMIT APPLICATION APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 16t-10 L,0p67Nj4A0FK RdAn FL81M RIFp LF E _;yget�
Legal Description: 13 55.317 r gT PAiLT dE 5 yZ 6 F Auji�s/
115 IJ Zg; Fr AWD s sh a I A Fr &Q7 At 7 Z
Property Tax ID#• - Qooz-pog-I Lot No,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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it ona work to be erformed under t Is ermit-check a appy:
HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric a Plumbing Sprinklers Generator• Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$_,,S'OfJ• coo Utilities;OSewer aseptic Building Height:
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Name FAniNIp. MK75 Name: p
Address: 14ZZIDAL1,4c 9AP_lLWAV #1000 Company:
City: IMU43 State:_ML Address: W 51
Zip Code: 752S'4 Fax: 7 City. �Mja I
. Stater
Phone No. 4'7'7-YTS - 1661 Zip Code: 3812, Fax: 726-&,0-57(Q0
E-Mail: Phone No. 305 r Q2 - 5
Fill in fee simple Title Holder on next page(if different E-Mail:�L Q}gL,�5A f tZ /rlrRl(. (flA/I
from the Owner listed above) State or County License: I& liLtl-794
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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:
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 thepermit 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 the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recQrftg your Notice of Commencement.
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_Signature of OwrrL /Agent Signature of Contractor/L' a se H der
STATEOFFLOR STATE OF FLORIDA
COUNTY OF U1ftm I-tA1pE COUNTY OF M i j1Mi - bA DE .
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2-if day of 20 Eby thls_Z�L day of Ae'W L. 20 J by
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(Name of a son ackno I 1NALV MARTINEZ (Name f son acknowledg n iF INALVIS MARTING
yy ;'f MY COMMISSION#PF1515t9 �1 '3 MY COMMISSION#FF75151
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IJCPiR�S August Y4,2018
40 EXPIRES August 1a,201
7)398.0153 Floridallota,yServicexcm
(Sij'M,9tde of Notary Public-State of Florida) (Sign6td(4 of Notary Public-
Personally Known OR Produced Identification Personally Known OR Produced Identification (
Type of identification Produced L-r52y-.QDa -74--3&6-j_ Type of Identification Produced &57 y-oQ0--7y-,j6ti-)
Commission No. FF 15j5t8 (seal) Commission No.•r� 1.51.x,1$ (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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