HomeMy WebLinkAboutBuilding Permit Application 05/27/2015 11:53 FAX R002/003
ALL APPLICABLE INF 'MUST BE COMPLETED FOR APPLICATirON TO BE ACCEPTED
Date: .. . y6 I sv Permit Number: SLC IsQS- ® IOD
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- Building Permit Application
Planning and DevelopMentServices
Building and Code Regulatiah Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)4621553 Fax: (772)462-1578 COmPne'rCial Residential /V
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PERMIT APPLICATION FOR: To Select from dropbbx, click arrow at the end of line
Address: 07 p ;,L feA &,ze,4 �G• �•
Legal Descriptiop: V G'tn40q Oa U�t 42
Property Tax ID#: 45-i l - c605-- 604-7-- ooc) _ 3 Lot No.
Site Plan Name: ? Block No.
Project Name:
Setbacks Front Back: Right Side: i Left Side:
hz,l bey NAley
itiona wor to e e lormed under tis permit-c ecK all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers ElGenerator D Roof
Total Sq. Ft of Construction: Scl. Ft.of First Floor:
Cost of Construction:$�60"�� Utilities Sewer Septic Building Height:
Name r✓� Prr/�i2f Name: o
Address: O Dl � �� , w_d 99 :Company: t ► rl+tn �►�
City: ��Gi .l af%� State: f:—�' 'Address: k '44W w� v .
Zip Code:_ � Fax: City O Cit' ��`.- t^e- Stater.
Phone No. :cr� /fC 3 °Zip Code:�'i 01$4 Fax:11-b-'B j 1-
E-Mail: :Phone No. Z"
Fill in fee simple Title Holder on next page(if different :E-Mai!^ a Ann+no �DG �►in�-tin `o��+"+ t•toy,
from the Owner listed above) 'State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Cominencement is required.
05/27/2015 11:54 FAX 10003/003
DESIGNER/ENGINEER: `Not Applicable 3MORTGAGE COMPANY: `Not Applicable
Name: ,Name:
Address: %address:
City: State: pity: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable j'BONDING COMPANY: ,Not Applicable
Name:_ ;Name:
Address: ddress:
City: ity:
Zip: Phone: Zip: Phone:
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I certify that no work or installation has commenced prior to fhe'isJuarice of a permit.
St.Lucie County makes no representation that is granting a permit Ill authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules;bylaws bran covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association anis review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do heret agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes at&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 Commencement may result in your paying twice for
improvements to your property..A Notice of Commencem' drat must be recorded and posted on the jobsite
before the first inspectio . If you intend to-obtain financing,consult with fender an attorney before
commencingwork or r rdin our Notice of Comm6ncement
Si n ture 6f—OvKerl gent/ see Sig&ture of ContractorFU a Holder
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STATE OF FLORIDA NATE OF FLORIDA
COUNTY OF���i ..Gt/CG^P _ COUNTY OF � 74<"G
The forgoing instrument via acknowledvpri hefore meThe forgoing instrument was acknowledeed before me
,
thisday of o?o1.S_'by Is 26day of /yL4nif a0.1jby
(Name of person acknowledging) (Name of person acknowledging}
(Sign of Notary Pu ' - tate lorida} (Signa tu Notary Public-S e Flo a)
Personally Known d frientificalion Personally Known Q OEI:Pr &ftrrpfgg(gp,
Type of IdentificatioPr ¢ LESL13 Type of Identification Produced: N
MY COM ION#FF465t 72 EXPIREf�JctQber 1,2018
Commission No. iN. 0 Corlimission No, ea
arf PII4E October 1,2018 :-!:153 Florida otaryervlce.com
Poll 3980153 FlorldalloI Servlce,com
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW RtViEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS