HomeMy WebLinkAboutBuilding Permit Application ,r PLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
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ate:
-,�-/f �D o,¢M Permit Number: J ' V���
RECEIVED
Building' permit Application JUN." '2015
planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax:(772)452-1578 Commercial Residential
"�TPPLICATl4N FOR:
Address- tf 0, �
Legal Description:
Property Tax ID#: ��2 ' '���r � Lot No.
Site Pian Name: Block No.
Project Name:
Setbacks Front Back: Right Side: _ _Left Side:
Zlfte- /4r- 1,1.'[c .2'1°v\ /.S Sect- CAA nSc, O
it na work to De performed uncler this permit–check all that apply,
_„_Mechanical V Gas Tank —Gas Piping _Shutters Windows/Doors
Electric J Plumbing Sprinklers i Generator Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ .`sem 7 Utilities: _Sewer _Septic Building Weight:
Name Name: Ltrtts S=Mon
Address: ,� � _ Company: 61, m Air 5!4-s+ems bu ce
City: State: Address: 1�15 S i- Vi l(j2QB Iy 1)r'
Zip Code: Fax: City: P-ORa 5T C ice. tj _State:.
Phone No. / a� l�a� Z9p Cade: ° Fax:
E-Mail. Phone No.__ 77,2 3 ,S -3 �.
Fill in fee sample Title Holder on next page(if different E-Mail: e,sA'ck it r,-4 P 0 01•c c.
from the Owner listed above) State or County License: C.A C 0 S 10
If value of construction isxliWor more,a RECORDED Notice of Commencement is required.
POE"SIGNNERENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: --- - — Name:
Address: Address:
City: -- -- State: City: State:
Zip:^ Phone: - -- Zip: Phond:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING 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 aAermit 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,l 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,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 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
commencin work or recording our Notice of Commencement.
Signature of owner/Agent/Lessee Signature of Contractor/License Haider
STATE OF FLORIDA STATE OF FLORIDA
COUN'T'Y OF Q 7 L-V c t CIDUNTY OF� e5 i L
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this day of k^_L 20 IS by this J day of 2o�by
11rt1S inmon
(Name of person acknowledging) (Name of person acknowledging)
Z' � � A�
(Signature of Notary Public-Sta of Florida) (Signature of Notary Public-State of�06rlda)
Personally Known OR produced Identification Personally Known_'_/_ OR Produced Identification
Type of identification Produced r R END Type of Identification Produced_
* * W MMISSR?N f EE •r9 IAY _
Commission No. S9 EXPIRIG:Apri14,2017 Commission No. d, MOM
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�� EXPIRES:Apr119,tat
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SE"ATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE _F
COMPLE=TED
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