HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: • �,tp� �� /�. �. Permit Number:
1 `7
RECEIVED
Building Permit Application
JUN 2 6 .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
PERMIT APPLICATION FO''
Address: oy 2 10 �� S� ►��' ��� r� IP��=12C'c f ��tl z
Legal Description:y;cuo,o� 2 -13 060 Z —cloo
Property Tax ID#; .2 L/ 3 r m�a,Z �' ° U a Lot No.
Site Plan Name: Block No.
Project Name: 1��� /ryP�1"�t<«(C � �f�f
Setbacks. Front Back: Right Side: Left Side: !�
LA C_W W UJ
Additional work to be pertormed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _'Shutters indpws Doors'
_Electric _Plumbing _Sprinklers Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:.
Cost of Construction:$ 00,00 Utilities: _Sewer .Septic Building Height:
Name 1c . ' Name: -
Address: -16V2_ 7�+'y/2/1o^ (�/✓� Company:
City: fowl ,Pr€124 -State: • Address:
Zip Code: 3 1/ Fax: City: State:
Phone No. 772 S`� Zip Code: Fax:
E-Mail: 1,4U1Z/1�-i7242 60,,4 cif Phone No
Fill in fee simple Title 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 COMPdNY: _Not Applicable
Name: lItxJ�4l�pS Name:
Address: ��/ ��«ad� oAddress:
City: od 41f�r-e' State: L City: State:
Zip: Phone 17�0 77 S/ 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_ito 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 of Owner/Les ee/ ent *Nor
,y.• ..�; Signature of Contractor/License Holder
=rE�
STATE OF FLORIDA
o .•: STATE OF FLORIDA
Z R, „*,,.
COUNTY OF L COUNTY OF
The forgottinstrument was acknowledged bef om The forgoing instrument was acknowledged before me
this . ay of -,J 0 ti3O 20115 y cn�,V this day of 20_ by
AaL
(Name of person acknowledging) N (Name of person acknowledging)
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4L 134.4
(Signature of N ry u lic- tate of Flor da) (Signature of Notary Public-.State of Florida)
Personally nown OR Produced Identification Personally Known OR Produced Identification.
Type.of Id ti do /1 Type of Identification
Produced ,X/t Produced
Commission.No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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