HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED
Date: �' �' l•� Permit Number:
RECEIVED
BUilding Permit Application JUN" Aq 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 V
PERMIT APPLICATION FOR:
IN
Address: 6qo 5 e_u
Legal Description:p1-K7 2- `
PropertyTax ID#: -j0-b-oo -L _0(_90 - Lot No.
Site Plan Name: Block No. �35
Project Name:
Setbacks Front Back: Right Side: Left Side:
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_ ,
Add
-itional work to be pertormed un der this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
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Total Sq. Ft of Construction: __ Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer Septic. Building Height:
WE
Name
City: -0 = e ( P State:_ Address: r P P
Zip Code: J „ State: —�
Phone No. - Zip Code: < Fax:
E- ail:- _. Phone No _
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Fil in;.fee simple Title Holder on.n ge(if different E-Mail 2 e NA,t P V e� ��ofLt,I�c'l 0 N CJ
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froin �e°t e'Owner listed above) .� State or County License C_CTC t 5Z 1508
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If val- .6-ristruction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name'
Name:
Nam
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..
l.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 jobs'ite
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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Sign ure of Owner gent Signat re of Contractor ice Wder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_ FA v COUNTY OF
The forgging instryment was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 tby thisZ'day of v �`' _J 2675 by
(Name of perso acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida_) (Signature of Notary Public-State of Florida}
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Personally Known �'""P*R Pry � n 4f�!Notary
fiO Personally Known OR Produced Identification
Type of Identificat a. • ; . My Comm.Expires N1,2016 Type of Identifica 'o
Produced oes Produced ,,,,,,,,, LUZ vi Ln.sea
ion#EE8616
OFF��� S�2�ts s`cs Notary Put)[ic -Slvk.e' '' "':; iii
t+ Bonded through National Assn.
Commission Na Commission No. Z. * « •` rn ca ,. (Seal) ¢r
Bonded lilt v.; "`,•:'r.'y RSJr�.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVI E IE
+s r PU LA LIJVELASCO
DATE ;���t .�'s Notary Public-I tate of Florida
RECEIVEDcityllf S NOV 1,ZU15
DATE Commission A EE 848616
COMPLETED °;;"
ev.7/2014