HomeMy WebLinkAboutBuilding Permit Application MAY/12/2015/TUE 02: 15 PM AAS Rescue Rooter FAX No. 772-794-9783 P. 002/005
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 1�� 5 Permit Number: Sd 5 'd 15Co
RECEIVED MAY %13 2015
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)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Add ress:
Legal Description: SLan-Lin
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Property Tax ID#: GLot No._
Site Plan Name: Block No.
Project Name: CD
Setbacks . Front Back: Right Side: Left Side:
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Additional wor to be ertormed un er t is permit—c ec a appy:
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HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric 0 Plumbing Sprinklers E Generator 11 Roof
Total Sq_ Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ a� o� Utilities:LSewer Septic Building Height:
Name 01'el'h Name: i
Addrests: 1=() L�D L] Dr- PD+ AfK- Company: nV C,
City: bfnl State:_L_ Address:: 2,%00 03 14W!J
Zip Code: � f 5 A
+ Fax: City: &.ro- ow—G'C'h State:_,
Phone No.. -ol) ( 2315 _-- -__---- Zip Code:. z 9 Igo Fax: Z • 9_7 $3
E-Mail: ISG Me Phone No. -7 Z /
Fill In fee simple Title Holder an next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction Is$200 or more,a RECORDED Notice of Commencement is required.
MAY/12/2015/TUE 02: 16 PM AAS Rescue Rooter FAX No, 772-794-9783 P, 003/005
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DESIGNER/ENGINEER: _EPNot WAppl!Mcable 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 maces 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 following building permit app[Icatlons are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen roams 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
befor the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comyhoncing work or recording our Notice of Commencement.
A IY7A-t W Z"?CA iZarjk
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_Signature of O rner essee/Agent Signat re o ontrac or ' ense Holder
STATE OF FLORIDA � STATE OF FLORIDA, t
COUNTY OF `'5A—Lu GvCOUNTY OF ``b t_JJ C. -Q.
The forgoing Instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I-day of Vnp" 20 Eby this day of 20 _JrJ by
(Nason ac wledging) (N f persp knowledging)
.l
(Signatu Notary Publl a of Florid (Signa ure of Notary u c-State o rida)
Personally Known A OR Produced Identification Personally Known OR Produced identification
Type of identification Produced Type of Identifieati n Produced
Commission No. _ mmisslonNo. (SealETH A VERBY
g } pB '
ION#FF220 MY COMMISSION 4 FF22
0
MY COMMISfi0
EXPIRES April 18,20-145 2019
18 _
c 1 �o+idallo,aYsr�xi.corr
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS