HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED c
Dater Permit Number:
RECEIVE®
Building Permit ApplicatioAUN 12015
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
as
Address: Q�0% �/� . CIT
Legal Description:
Property Tax ID#: / 13d - 2(0S'- 00/ " 6;Y)0 ' : Lot'No.
Site Plan Name: Block.No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
------- Bills= Mxm
E'er '`:r C' n C e v an
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will
ROME=_-, ION
rtiona work to be perrormed WunerPIS ermit-check a ,t ,at;gpp y:
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:"$ . S-C) O Utilities: _Sewer _Septic Building Height:
Name N Name: ON G 2G6-TSI
Addresst CI 7M bl,A I I deCompany: lo/4 Go-III ��-EC C ( (_C.
L
Cit L7r l , GaCL State: Address: 5 w `5 _e�1
Zip Code: �4 C,SSU Fax: City:�ci ,i-m e, Stater
r
Phone No. C' , - �D Zip Code:39q(0- Fax: X1
E-Mail: A VI-NTLI% 2- v - COA4, Phone No
Fill in fee simple Title Holder on next page(if different E-Mail a "G
from the Owner listed above) State or County License / )
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNERANGINEER: __ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address• Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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 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 Horne 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 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
comme,"ing work or recording our Notice of Commencement.
21
Signature of Owner/Lessee/Agent ?; -Signature of ContractorJLicense Holder '' =
STATE OF FLORIDA4 �, STATE OF FLORID
COUNTY OF = COUNTY OF
• rtyJ m X�
The forgoing inst ent was ac nowledged befor Mdisa m The forgoing instr ent wa acknowledged be rM.0-
this day of 20�Aby g this day o 20�b
25 T O at Q=
ase
Name of person ac nowledging) (Name of person acknowledging)
4,!:A
�' � &X�
(Signature ofo ary Public-State of Flori V (Signature of Not ublic-State of Florida
Personally Known OR Produced Identification Personally Known �OR Produced Identification
—
Type of Identification Type of identification
Produced Produced
Commission No. (Seal) I Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.