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HomeMy WebLinkAboutBuilding Permit Application Al- ,PPLICABLE INFO MUST.BE COMPLETED FOR a6PPLICATI4DMTO BE ACCEPTED Date: lS Permit Number: I Sd 5�p337 "O,MAY 2 2 2015 Building Permit-Application Planning and DevelopmentSL-rvites Building ownd Code Regulation Division 2300 Virginia Avenue,Fore Pierce A 34982 Phone: (772)462-1553 l=ax: (772)462-1578 Commercial � Residential PERMIT APPLICATION FOR: . M�cin d►n ,%c,q Address: vl rxz d f Legal Description: Property Tax SD Lot No.� _ Site Plan Name: Block No. Project Name: Setbacks Front_ Back: Right Side: left Side: I lonal for o e pertormecl uncler this perms --checK all tat apply- -Mechanical ppy:_,,Mechanical —Gas Tank �Gas Piping �Shutters �Windows/Doors Electric Plumbing Sprinklers _Generator Roof Total Sq.Ft of Construction: Sq. Ft.of First Floor: s Cost of Construction:$ Utilities: —Sewer ®Septic Building Height: Nameli-Ma z&dk 6& 'Olrd,. !Name: 2 41 ©Yl Address; 5z.7W lfld Company: 6 .ea M Air LA ' .+e'M z )lu C.-- City: '44;e'rt r 1 r E- State: - ,address:�i�15 S � �i I(�a��rer'r �r • _ Zip Code: -IW5. .ZFax: City: o "C i L.ur tilp_ &J State: R. Phone No. �'fy�� ��' zip Code: 3435%.__ Fax• '17;. 3 l E-Mail, - - - — Phone No. 77d Fill in free sample Title Holder on next Page(if different E-Mail, C. tair a w s y coo I-(,= Mt e ner listed above) State or County License: CAC 0 S i ID if value of construction is or more,a RECORDED Notice of Commencement is required. 7 �� DESIGNERANGINEER:"ot Applicable MORTGAGE COMPANY: Not Applicable Name: rlwlame Address: Address: City State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: ,Not Applicable BONDING COMPANY: —Not Applicable !Varna . fume: Address: Address: 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 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 Buiidil)g 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,wails,signs,screen rooms and accessory uses to another non-residential use WARNING TO OWMER:Your failLire 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 aobsite before the first inspection. if you intend to obtain financing, consult with lender or an attorney before commencing work or recordinpyour Notice of Commencement. J6 Signature of Owner/agent/Lessee Signature of Contractor/iicense Molder STATE OF FLORIDA STATE OF l���t� COUNTY rCS�t'��tt�A �r 1 c� COUNTY OF 7 ��C t.. The forgoing instrument was acknowledged before'me The forgoing instrument was acknowledged before me this d/ day o€ 26LS' bythis day of �- --=2OZ,5 by 41-in m ori (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-Stati"of Florida) (Signature of Notary Public State o€ rlda) Personally Known OR Produced identification_ Personally Known _ _ OR Produced Identification Type of identification Produced 140 F0.41. n imam t Type of identification Produced 4*OF11) BYAS / �IAY COMMIRION I EE 859213 Commission No. t� ExpiRES,April4,2017 Commission No. �syzf MYCpp ismI Bendae t1xsi ducktstNcleri S EXPIRES:April d,28f REVIEWS FRONT ZONiNG SUPERViSOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED -Rev.