HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUSTBECOMPLETED FOR APPLICATION TO:BE ACCEPTED
Date: �" . /. Permit Number: / r
RECEIVED
Building Permit Application _JUN -9 2015,
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 _
PERM IT APPLICATION FOR: �om®
Address:-9-54 C.� S��C�`etSSJk
Legal Description: Q
Property Tax ID#: �'I S^- ��'�n�2-y' —C�C��-�o Lot No.
Site Plan Name: ` �\ Block No.
Project Name: - z
Setbacks Front Back: Right Side: Left Side:
WW�0121 iii,
main long
Adclitional work to bepe orme under tispermit-check all t;atapp,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:$ D , 0(o Utilities: _Sewer _Septic Building Height:
P,
Name �J� a f1, Name:
Address:DN57LPnkompany:
City: m\M State: M- Addr s: � ('A i
Zip Code: �' Fax: City: Cv� State:
4 U
Phone No. d�- �J(P c� 1 Zip Code: G'iG1(a Fax:
E-Mail: Phone No Z 94".b—
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Fill in fee simple Title Holder on next page(if different E-Mail � C�C-�
from the Owner listed above) State or County License A DC54
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 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 thepermit 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.
Signa w /Le / ent Signat&of C tractor/Li a HoQ er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
4 U N
The forgoing ins e t was acknowledged b 1 � The fo oing inst m was acknowledged befog MP9 i
m ..
this day o 0 20, MLU
this�day of 26 by
ccgQ 2 Z�
agar o m`"� g
l �� oar
(Name of pers acknowledging •' "'`�:I (Name of persona nowledging ¢jw a
(Signature of ary Public- tate of FI rida) (Signature of No Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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