HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ¢�
bate:
Permit Number.
� i iN uui
Building Permit Application MAY 2015
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 �.
Phone:(772)462-1553 Fax:(772)462-1578 ilmmerdal Rest&n"
PERMIT APPLICATION FOR:
-PRO00SED1NPROVEMENT'LOCATIQN
Address: 21,64 N.
t
Legal Description•
i
PropertyTaxlD#: Lot No.
Site Plan Name: Block No. �a
Project Name: 1J*t n 3`
Setbacks Front Back: Right Side: Left Side:
DE'Ti41LED:DESCRIPTION OF WORKx ` 'r
1
• N -
Aft:
cONSTRUCT#oN
FOR TI
Additional war to beperformed under this permit-check all that appy:
Mechanical Gas Tank _Gas Piping —Shutters _„_Mlindows/Doors
_Electric _Plumbing —Sprinklers —Generator Z oof
Total Sq.Ft of Construction: �'5_or Sq.Ft.of First Floor: A[.17 /�
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OW,NER fESSEE
Nam WaA Name:
Address:32-9:3 141kh eA1 , Company: ('011 11)A Raffind I Ty.
City. State:` Address:Ra (ix 1-2-'Riot
Zip Code: Fax: N A City: PT2re . State:tZ
Phone No_ b C _ .� Zip Code: ?,LRJq Fax: JAI
E-Mail: NIS Phone No. 2
Fill in fee simple Title Holder on next page(if different E-Mail:
from the owner listed above) State or County License:
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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i&SUPPLEMENTAL CQNSTRUC>TION UENI�lA1N INFORMATION ; } k F $ Y
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: k V1 I nO Name:
Add re l,f�" Address:
City: _ r State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: 110
Address: Address: n
City: city.
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
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 Assodation 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 1 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 Commen men result in your paying twice for
improvements to your property.A Notice of Commencemen ust b ecorded a d posted on the jobsite
before the first inspection.If you intend to obtain f9nancin con th le r an attorney before
commencin work or recordin our Notice of Commen ment
i�1®R r7r'L
44, V[/-Z' MIX?
Signature caner/Agent/Lessee Si or License Holder
Tenness�.
STAF-l0MM STATE OF FLORIDA
COU OF H w��c;�► COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this F-1+day of Md 2kti by this day of /"19 Q V _20/S by
OC PCZ 11 JeJ
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of+k"ida) (Signature of Notary Public- to of Florida}
Personally Known " OR Produce e �tfr,'_� Personally Known
Type of Identification Produced �' "� Type of Identification Pro u�...got%
Commission No. (Seal)r �fG55� mm'ission No. a. •n' NQ- ublic•State of Florid
,`AttL N ate,=Myo ssion Expires Jan 4,20
M �h �X II-a(�r �' \G ��,;;o� a;••'� Commission#!FF 074781
pION
REVIEWS FRONT ZONING PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014
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