HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 8,`� 5 Permit Number: 15 O`� -0'J y�p
RECEIVED AN24.1015
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)462-2578 Commercial_ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PIROPMf=la fit` "Address: GT
Legal Description: ta&Z= eASg-&2N r I '{Yr K in /4Mil(MAP U/J4t) JCL!;7a,4 l$1)
Property Tax ID#: d I- Lot No,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional worl to a orme under t is permit---h eappy:
11 GasTank M_ []Windows/DoorsIVAC ❑
FElectric 0 Plumbing Sprinklers ❑Generator Roof
Total Sq.Ft of Construction: . S .Ft.of First Floor:
Cost of Construction:$��d•c'd Utilities- Sewer Septic Building Height:
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Name_Fg146jloc AAR¢ Name: AL:I:tJ(AddbE#- &QN2ALe2 ,
Address: Jc4Z7J QALLAS_--PA& wr+tl J�_rwe Company: GAIZ 4l R. LW0 nnh 1C�
City:_�ftAL(As Stater Address: LZA0 ►u) -z.%T
Zip Code 'S7_Je4 Fax - O- City: tk State:-P-L
Phone No. C7w 7'7g-q(o&_3 _ Zip Code:57,t2RS Fax:_786- 60, (o
E-Mail: Phone No.-309-R24-•Zxa'.5_
Fill in fee simple Title Holder on next page(if different E-Mail:,S•�SAlR Q &M&L_In,u1
from the Owner listed above) State or County License:_ LAG i R 17"195
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: Add ress:
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 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 5t.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 recording our Notice of Commencement.
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Signature of owner sse ent Signature of Contra a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Milo,,Mj COUNTY OF Mt A9d1t _
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_?Adayof ApMII_ 201,r-by this_M day of pm L_ 201Lby
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(Name a e on acknowl d 9g^ww, ame f e,son ackno e
,of `°�i INALVIS MARTIN �• `� INAt.VIS MARTINEZ
MY COMMISSION#FF15151 `�' g My COMMISSION#FF151518
,Frtio EXPIRES August 14,201 `�.? � EXPIRES August 14,2018
( I uof Not Pub ota ysevioe.com ure of Notary Pu r NataryServic3.com
Personally Known OR Produced Identification k Personally Known OR Produced Identification
Type of Identification Produced b %3g,-1 Type of Identification Produced_,,3Zc/-000 7y -3CG I
Commission No. FIr kKI5t$' (Seal) Commission No. I✓1=Ill Ird (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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