HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST-BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:� \ Permit Number: .• 50G d' 535
RECEIVED JUN'2.91015
Building Permit Application
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772.)462-1553 Fax; (772)462-1578 Commercial Residential �-
PERMITAPPLICATION FOR: P Ij' oue, 6v-bu ISG(
POO
Address: ���o(. • -�ar-�}1y(r_�—�C.(
Legal Description:
Property Tax ID#: j — �e9 00 S -3"0W r Lot No. .
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: •Left Side:
Foe �� (o o f (J 4z
T
onal work to med un er t is permit ck all t-at app 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 Height:
ffimm
BONN
Name ]) Qi PIF l•T0(�.Q� Name: ILL
Address: t t oC4)aipaay:,,k:, t.-
City: (�Q c> �MAf1s li{ F
State:{� ,;;A dress:
Zip Code: 3g eQr Fax: "City: State:
T
Phone No. Zip Code: . Fax:
E-Mail: 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.
- _ -- = T___
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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
Na me: Name:
Address: Address:
City: c City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to-obtaln 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.the permit holder to build fhe subject structure
which is in conflict with any applicable Home Owners Association•rules,bylaws or and covenants-that mayltestrict•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 undergping"a full cbhcurrency.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/L—esse6/Agent Signature of Contractor/License Holder
STATE OFFLORIDA- .'.'STATE OF'FLORIDA'•'.
`COUNTYOF ' �}:)�Q���� _ COUNTY OF
The forgoing instrument was acknowledged before me • The forgoing instrument was acknowledged before me
this [L' :day.of �,li�r.� .20� by this 'dayof .20 by -
(Name of person acknowledging) (Name of person acknowledging)
gna ure of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced IdentificationPersonally Known OR Produced Identification:
.-Type.of Identific tion Type of Identification
Produced TL Produced
Commission No. Smmission"No. -(Sial).
HAHNA•INGRAM
Notary Public-State of Florld
REVIEWS FRONT ":� j- Com 1 F LANS VEGETATION SEA TURTLE'` MANGROVE
Y. aea th o F£tyd Asn_77_,jVIEW REVIEW REVIEW _ REVIEW
COUNTS •�,�EW --�-.�--.T.
DATE
RECEIVED.
DATE
COMPLETED
ev.7/2014