HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
INN RECEIV"-70 MAY 0
Building Permit Application
Planning and Development ServicEs
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Fk 34992
Phone:(772)462-ISS3 Fax:(772)462-1578 • ReSidential x
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Legal Description: MS UVIA- ?,01 Ana Tro Q ♦AT,- qwf "n &Mrncn
Property Tax ID#: 147.5 [AQ b CX57 QM 9 Lot No.
Site Plan Name: Block No.
Project Name: Zn\Lo )ft3oXN
Setbacks Front__ Back:_Right Side _Left Side:
—Additional w&Rto,bLq p-E itormed under this permit-Check all that apply:
OHVAC "Gas Tank F]Gas Piping shutters []Windows/Doors
■ Generator •Roof
Electric Plumbing OSprinklers
Total Sq.Ft of Construction: Sa.Ft.of First Floor:
Cost of Construction:$ Utilities:[]Sewer Septic Building Height:
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City: gnfA State:��L 1 lot
Zip Code: q i4 CIL Fax:
Phone No.iaa��213.-12W rg
E-Mail:N/A
Fill in fee simple Title Holder on next page different 11111105M.
from the owner listed above)
if value of onstruction is$2500 or more,a RECORDED Notice of Commencement is required.
MAY/05/2015/TUE 07: 13 AM ARS Rescue Rooter FAX No, 772-794-9783 P. 002/005
DESIGNER/ENGINEER: x Not Applicablem MORTGAGE COMPANY: x Not Applicable
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Name: Te:_
Address: Address:
City: State: City: State:
Zip: Phone: Zip, Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x 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 Assoc E tion 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
co cin work or re ording your Notice of CommencemeA
Ign of Hold(
—Signature of O�b�eessee/Agent Signature of Contract icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF stwda COUNTY OF_!1.was
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this S day of fLgt L.4_ 70 alby this-5-day of 'Mc" 20 V5 by
Dennis Zatek
(Name of person acknowledgLing) (Name of person acknowled&L'ng)
(Signature of Notary PublIC-Ake of Florida) (Signature of 0`61-a-r-yFultilic-Sta(exFlorida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of IdentlficatloA'Produced
Commission No.
0 Sion No. (Seat)
10, AWN A ER
"W".- .. .- H A OFRIBY
JCF922093D
Revised 07/15/2014
—7 7!
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANOOVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS