HomeMy WebLinkAboutBuilding Permit Application COMPLETEDALL APPLICABLE INFO MUST OF r APPLICATION / •
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Building Permit Application RECEIVEJ
Planning and Development S- JUN 1
2015
Building and Code Regulation Division
/! Virginia Avenue,Fort Pierce FL 34982
Phone;(772)462-15S3 Fax:(772)462-1578 Commercial Residential
PERMIT
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Address-
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Additignal work to bg-pertornled under this permit'Zcheck al apply:
LiGasTank ElGas Piping •• ••
Tot al Sq. of 1 • y7S11Ft of First ■•
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Name Wo S Md _
ZlpCode, '15M &U,
Fli I In fee simple Title Holder on next page(if different E-M a i 1: T-1 teF.41 A
from the owner listed above) n.;a
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DESIGNERANGINEER' of Applicable MORTGAGE COMPANY: �Not Applicable
Name: Name:
Address: Address:
City. State: City: State:
Zip: Phone: Zip:_Phone:
FEE SIMPLE TITLE HOLDER! V Not Applicable BONDING COMPANY: of Applicable
Name: Name:
Address: Address:
City: city.
Zip:-Phone: Zip:_Phone:
I certify that no work or instillation has commenced prior to the Issuance of a permit.
I Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
ch is in conflict with any,applicable Home Owners Assocltlon 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 Notlee 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,
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Signature of Owner/Lessee/Agent Signature of Contractor License Holder
STATE OF FLO STATE OF FLOP4D
COUNTY OF COUNTY Ole
The f"olng instyqment was acknowledgeobefore me The f - oing*,nstrLqnept.was;acknowledgedpefore me
this LLU.As_'� 20 K�y this of
day of day .2-0 ]!a by
(Name of person acknowleidging {Name of person ackn6wiedging
A Ara
(Signature of Notary ruljcState of Florida (Signature of Notary Pubi c-State of Florida)
Personally Known Personally Know
uceu off`
Type of Identificatid _P Type of Identl4ca CRVSTAi ttlf:v%10
Ids
001
Commission No. a Commission No.. M coin':�. r. Commisaian�iE6<`�.7�,d7d u� p m 0*:
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,Rrvised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
60/Z0 39vd N3IW3dc1 V60TZ69ZLL 6T:9T 0TOZ/80/90