HomeMy WebLinkAboutBuilding Permit Application MAY-05-2015 TUBE, 01 ; 44 PM CENTRAL SCHEDULING FAX No.. 32126861 8 P. 2
Date:�./ Permit Number:
i
Building Permit Application
planning and DevelopmentServfces
Building and code Regulation Division
2300 Virginio Avenue,Fort-Pierce hL 3.4982
Phone:(772)462-ISSB Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox,,click arrow at the end of line
,} .r ..}. .�. 4r r
N' �`{. ' n?; A�>�" 35:'1 ri iLk � '1 1W M I r
Address: �� fl 5-6,q&'2-
Legal
ZLegal Description: r i• (?
Property Tax 1D#: �J""'S1Q' ��1 7` i-�.i �� Lot No. _
Site Plan Name: Block No.
Project Name'
Setbacks Front Back: Right Side: Left Side:
t' � i��'� G''5�'dm t r�,� �,..r} fid'"4 i+tti ryn7`�ta'. IY�»t i tRi k `•� Pr•r � r�P�d it '"1 ��'�Fu r edd �I SSi{� {T i i. t
H r.
211"
c° �
!' r f 1ma
" r m FS46 r v rout
h "ra
't .Wall d
aaT�t' 41 `�,�' e.
-Additional work t oiertor`me un er t rs permit-check a apply:
I'HVAG _i Gas Tank E]Gas Piping _Shutters O Windows/Doors
Electric ElPlumbing Sprinklers Generator !�-r Roof
Total Sq.Ft of Constructlon: _- S .'Ft.of First Floor:
Cost of Construction:$ Utilities_05ewer IjSeptic Building Height:
FIN,
�'���
,! u I !?! {
Name
Ct! Name: ® ��-
Address'� d ( Company: �J
e"
Zip Code:r
City: � State Addrv ' T;
Fax: City: � Stater
Phone No.; w-iocA' s-) Zip Code: Fax:
E-Mail: Phone No.���
Fill 1.n fee simple Title Holder on next page(if different (=-Mail O '
from the Owner listed above) .State or County License:
if vaiue ofi construction is$2500 or more,a RECORDED Notice of Commencement is required.
MAY-05-2015 TUE 01 45 PM CENTRAL SCHEDULING
FAX No. 3212686138 _ (P. 003
I{S.^ � °
' (1".�Q 51 aHyl'`••N}S. f l i�Id , iV ^l ...%i 1' ��1� a'li :5: ,t'�diN{i1i41,2i r:l l bl..l �O71... i1�J1-V .Y,:L 4 �J.4f -� sG:
DESIGNER/ENGINEER: Not Applicable M.ORTOACE 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' — TI P: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.LuciIn conflict with any applicable Home owners Associae County makes no representation that is granting a permit will authorize the permit h❑lderto build the subject structure
which is 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-residentlal use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying thrice 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 rec-rrling your Notice of Commencement.
Signa re of Ow /Agent/Lessee Sion Jture of C t or/Licehse Walder
STATE OF F RID t STATE OF FLORID
COUNTY OF 1��� COUNTY OF �,
The forgoing instrum�e�{t as acknowledged before me The fo Ding Instru t cknowledge efore me
this day of `1 1 20 by this day of z0 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature Q Notary Public-State of Flor a) (Signature of Notary Public-State of Flar a)
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of identification Produced Type of Identification Produced
Catherine lConger
a commission No., {'� -I -_�.�•" ""•.5
Commission No. �1`123"IZ. ., lod#FP172 �' ¢ �.� herine EGv>rlge�
€ ° plass:air ze,xoi s =Cammiss9oa ��z���
°nultinoRTIXIVNOTARY,L IST FLOOR DA.R0TA�R�,1,1CG''
Revised 07/15/2014
REVIEW5 FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS