HomeMy WebLinkAboutBuilding Permit Application ,,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATIOtITO BE ACCEPTED
Y)
Date: ra-1c Permit Number .
Building Permit Application
Planning and Development 5'ervices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce R,541982
Phone;(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:. f4� AIAA&011�
Legal Description:
Property Tax ID#: 7 0/_ Lot No.
Site Plan Name- Block No.
Project Name!
Setbacks Front Back: Right Side: Left Side:
ClAnSe- OLA
"It"lona work to be perrormea uncler this permit–Check all that apply:
—Mechanical Gas Tank Gas Piping —Shutters Windows/Doors
—Electric Plumbing Sprinklers —Generator Roof
Total Sq.Ft of Construction:. Sq. Ft.of First Floor;
Cost of Construction:$ I/ r Utilities: —Sewer _Septic Building Height-,
Name V4; 14 tf�e Name: olurtts sa.A'Anp-il
Address -1 T&M-Auz Rd Company: ca<lrom Vr $!42kms
City:_A"kPP,0_ State: Address: I,WS
rJ �state: FL
—
Zip Code: Fax- city: povc �T _Clcw - I
Phone No. %!rod*- 1.0 Zip Code: .AM , Fax: T7.2 MY I_Vg.8_
E-Mail: Phone No.. --- 77.2 53.15, -.3Q.1
Fill in fee simple Title Holder on next page (if different E-Mail-,
from this owner listed above) State or County License: CA C 06 1 R 10 54mi'2,'
If value of construction is 2Meor more,a RECORDED Notice of Commencement is required.
MDESIGNERENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: _-- _-_-- State. City: State-
Zip: Phone: Zip: Phond:,
FEE SIMPLI`TITLE HOLDER: _Not Applicable. ROh1DING COMPANY: —Not Applicable
Name:, Name:
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 ancovenants 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 Buildipg 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,wells,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failuire 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 recordin our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF�,v c�� COUNTY OF COUNTY OF u'i` Lv -I
e -
S 7
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged b fore me
this a day of i 20_!E by this_4 day of 2Q�y
('U r g tn rn otis L. Tis OFA mmr�n �.
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Statffof Florida) (Signature of Notary Public-State of rida)
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of Identification Produced �a►Y r,�,- ,.�, a Type of Identification Produced
1 M
E5�5��3'y - �I�r�olli�rorll>�I�e
Commission No. ) ERPIpE9:April;,2017 Commission No. ��5/d
* Cp118118$tONiff
">}�� ` earr�edTh+uBtNmen ,� gaEXPIAE9:11pn��,20f
wig ow
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
NOV.