HomeMy WebLinkAboutBuilding Permit Application c
.PiLICABLE INFO MUST SE COMPLETED FOR APPLICATION'TO BE ACCEPTED
'Date: e t -t Permit number: NMg � 2 21-0
RECEIVED
Building Fermat Application JUN 12 2015
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 3498,2
Phone:(772)4.62-•1553 Fax:(772)462-1578 Commercial Residential �
PERMIT APPLICATION FOR:
CRIMM M-101
Address: 5c,,-,k&. % -'`lc�ct
Legal Description:
Property Tax IPS#: 6 Li �� # i i t -ao�-000 S Lot Isla.
Site Plan game: Block No.
Project Name:
Setbacks Front _ Back: Right Side: Left Side:
(.,
\LV- e r �_;1�,�'� `�-t-a all Fcka'f-c36...e or,:A
1'3 9 r
91
tunaWworoepeNor"mepan er ss permsWc�hed(all:!�
aapp 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:$ `� �' Utilities: !Sewer _Septic Building Leight:
Name e v y,v _ c) C Name: &rtt S Sa;M m on S
Address- .5fitr C.. tic,-rata., Company: GA5TJjW Lr &�Sf.inS � !
city: ?ar-v t c-- State: L Address: 1W 5 S (1!2 v.
Zip Code- '-tn Fax: City: op�5T Luc.« State: L,
Phone No. ��� - 1 Zip Code: s Fax:
E-Mail: Phone No. 77,2 335--393'2-
Fill in fee simple Title Holder on next page(if different E-Mail' LUST—St" uii IP �o 1�C=
frorn the Owner listed above) State or County License: Chi C 05 t,$iQ 5��
if value of construction is 2.5Wor more,a RECORDED Notice of Commencement is required.
SIGNER'ENGINEER: „® Not Applicable MORTGAGE COMPANY: __NotApplicable
Name: mama:
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: Rhone: 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 permii.
St.Lucie Countmakes no represent tion that is granting a permit Mil authorize the permit holder to build the subject structure
which is in convict with any applicable Home Owners Association rues,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 respe'dtts,perform the work
in accordance with the approved plans,the Florida Ruildjpg 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 faildre to Record a Notice of Commencement may result in your paying Mice for
improvements to youir 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.
Olt-
Signature
of Owner/Agent,/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S-T +-•t1 C Ile COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_L�_-day of __,Z 15 by this day of tom.,e-. ,20-k 4:�.by
Irn m 0r -51 t�r2 r..ls -1
(Name of person acknowledging) (Mame of person acknowledging)
(Signature of Notary Public-Sta of Florida) (Signature of rotary Public-State oo6rida)
Personally Known OR Produced identification Personally Known OR Produced Identification
Type of identification Produced-, x A Type of identification Produced
}dY Ct7IA ESSIol+1#EE ,��o::,k
Commission No. Sy�� " a al) EXpJRE$,,April4,2017 Commission No. Y r1� �} + Imo$
osa� � iia>�sdrnn,t Ne4ure ; EXPIRES;Ap►i14,20t
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014
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