HomeMy WebLinkAboutBuilding Permit Application MAY/29/2015M I :10:05 AM ARS Rescue Rooter FAX No, 772-794-9783 P. 001/005
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO SE ACCEPTED
Date:
`.51 =ci Permit Number: 15O 5-0 `j 9
R E CE14"D MAY 2.9"2015
Building Permit Application
Planning and Development Services
Bullding and Code Regulation Division
2.300 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
Imam
Address: L4 L&Vt r I Z-o
Legal Description: 4i!An S± LUd P IdG IUnit Zai (6r 3S-3to 'toto7 �
Property Tax 11)#: d;L 0Q - ®19 Q - QC) Lot Na. — --
Site Plan Name: to ., Aolr�rxBlock No.
Project Name: U Yla.
Setbacks Front Back: Right Side: Left Side-
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ide:c�j CL`� �..vJ �UU1S�"eJ�V1
itwna wor toorme unclerthts permit—c ec all py:
HVAC Gas Tank OGasPipingShutters Windows/Doors
OGenerator
Electric Plumbing ❑Sprinklers ❑Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ �" Utilities: SewerSeptic Building Height:
i
Name Name:
' S
Address: tay-lif Company:.
City: q ick �g'kg, State., Address: 2KC= CJS 'I-LA-->U I
Zip Code: Fax: t1l City: 1EA-0 &AC�_ ► State: L�
Phone No. Zip Code: t3Z9 W FaxC772»i9• g-1 g3
E-Mail: Phone No. 2Z'7i�
Fill in fee simple Title Holder on next page(if different E-Mail: Y 61 0%-f,S Coln
from the Owner listed above) State or County License:��C�CP 7 c _
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
MAY%29/2015/FRI 10:06 AM ARS Rescue Rooter FAX No• 772-794-9783 P• 002/005
N=M; EMIR
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: -State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Xot 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 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 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 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
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.
_Signature of Owner/ &/Agent Signature of Contractor/Licao.P.Aolder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -- ' COUNTY OF S-F Lu e. e
The forgoing instrument
was acknowledged bef re me The forgoing instrument was acknowledged before me
this ,7�l day of ,0 1 LOV`7 20 / by th is A'J day of 20 11 by
' .Y11r�
(Name of person acknowledging) (Name of person acknowledgi
w
(Signature o Notary Public-S a e of Florida) (Signa ure of NotaryI�c-S,tate ida)
Personally Known OR Produced Identification Personally Known ' OR Produced Ident1fication
Type of Identification Produced Type of Identification Produced
Commission No.FIV2.z nq No. r— i. " Seal) BETH A DER8
�• • ,fTH A ERSY ••: MY COMMISSION#FF M
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Re'uiised 07/15/2014
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