HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED.FOR APPLICATION TO:BE ACCEPTED
Date: 15 Permit Number:
RECEIVED JUN 041015
Building Permit Application
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
PE RMITARPLICATION FOR:
znc
Ad_dr SZ l����' l ��t� zo T 1 :71�
Legal Description:
Property Tax.ID#: I q _5 ` 50 t f ~ 6 15S—000.--7 Lot_No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
91MIM' i WM ; I
yy 7- 0,11
Additional
,work to be performed under this permit—check all that appy:
_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 Gonstructia�r $-- PD U �hties: Sewer Septic Building Height:
Name: //n
Addr ss_. Company:
cit,yr —T ''�c,�r State:�r Address: ; L
Zip.Cbde Fax: City: State:
Phone No-- � _ - ��l —'Ir<1j6 9 Zip Code: Fax:
_
E-Mail: �+'; Phone No
Fill in fee i el itle Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zi-p: 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 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 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
commencing work or recording our Notice of Commencement.
Signature of6&,ner/ essee/Agent
-Signature'of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA .
COUNTY OF 5 k COUNTY OF
The forgoing instr ment was acknowledged before me Th'e forgoing instrument was acknowledged before me
this day of. O v\A-, .20� by this day of 20_ by
\.%d\ mu dl Cil
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary blit-State of Florida)' �G� eo& 2 6 'gnature of Notary Public-State of Florida
O�PNt, •S�a08�,61
Personally Known AOR Prod den nally_Known OR Produced Identification
Type ofadentificatio. N°� Type of Identification
Produced L c�p�i .° My;�� ° , : �' Produced.
_o�
_ Rea
Commission No. Cis$ Flea Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR 'PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.