HomeMy WebLinkAboutBuilding Permit Application ,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date, - ;;I()ill:-) Permit Number:
"PECEP' -0 MAY 112a
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce F4 349e'
Phone. (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: n 8 a,
Legal Description:
Property Tax ID#: 3L4 ai.4 01 bCY5,1 - wo- I Lot No.
Site Plan Name: Block No,
Project Name:
Setbacks Front Back: Right Side: Left Side,
7X'ko V n 0
Additional WoMto be pe Orme under this permit-ReCk all that apply-
-Mechanical Gas Tank Gas Piping —Shutters Windows/Doors
—Electric T Plumbing Sprinklers —Generator Roof
Total Sq.Ft of Construction: Sq. R.of First Floor:
Cost of Construction:$ y a O C1 Utilities: _Sewer _Septic Building Height,
Name_ Cal�r Name: Eurtl S AunWont .-
Address; Company: �1A,-n7m i r S�sfems gni c, - ---
City: State, Address: 1kls 5P_ T1 HOAR-
Zip Code: Fax: city- PC I?-C U cj State:
Phone No, Fax.
P k Zip Code: 34S
Yip
Phone No. 7yl
E-Mail:
Fill in fee simple Title Holder on next page(if different E-Mail: ttl sto,-vr s.Ld-A V_&L2
from the Owner listed above) State or County License.
it v.
if value of construction is 2400�or more,a RECORDED Notice of Commencement is required.
-RE-C"VD MAYA.U-ILUIA
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: ; Address:
City: State: I City: State: j
Zip: Phone: Zip: Phone: I
' FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name% Name:
Address; Address:
City: City: — -
j Zip: Phone: t Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as Indicated.
1 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 Suildipg 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 fallure 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. l
i Signature of owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S7 L V c i COONTY OV . L v
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this 13 day of MQ 20 15 by this day of rn a �,20 t5 by
L'_p_r f I C i4Irk m anS' _ C'tc 7,�_. #Aamr. 12
(Name of person acknowledging) (Name of person acknowledging) }
(Signature of Notary Public-Stat Florida) (Signature of Notary Public-State of rida }
Personally Known VI/ OR Produced Identification. Personally Known OR Produced Identification
"type of Identification Produced a Fha& Type of Identification Produced
e.
MYCOMMBSIONfEE ro��`%A"4 C,4r B. !
Commission No. ` Y al} EXpIRES;Aprd4,2417 Commission No. DP3�o1r� MYC�IMIS8tONfEE
omw Thfu OWO mdp sevs EXPIRES:Apra 4,201:
4+; 80*d
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE � MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW I REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014
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