HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO.MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0/2��5 Permit Number: -
Building pp Permit Application RECEi�/Er
-
Planning and Development Services JUL Z 2015
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X°
PERMIT APPLICATION FOR:
Address: 210 7 Ff e,-e /C e E✓ / 3 V99,
Legal Description:
Property Tax ID#: 1 Lot No. -
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: (tight-Side: Left Side:
30""64 S ��,� 4A �.�A C'Aon l 01 1 -'h -�i 110-r- of S
544 LAI h QA �r t't�c
Acid itional work to be performed under this permit–cneCK all t at app y:
_Mechanical Gas.Tank. _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing . _Sprinklers G9 era r ;"' '°L"`��17oof�
Total Sq. Ft of Construction Sq. Ft.of First Floor:
Cost of Construction:$ "may Utilities: —Sewer _Septic Building Height:
MIMI
Name 6CName: a
Address 16 Company: r'✓e S G r Fe ne e 1cun�
City: a Q,�.r c�C State: Address: 4 15 D / 3 5 4- 5
Zip Code: 7g9ft- Fax: City: ✓e,,', daraQ A State:
Phone No. 7 7 'a -7 9 e 30 Zip Code: Fax:
E-Mail: Phone No -7 `2�)L 74 3S
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License Z6 .�-
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 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.
Si ature of Owner/Lessee/Agent Si.gffature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �� ���, COUNTY OF
— L
The f going instr ment sac nowledgedbefore me . The ff�,going instrument was acknowledged before me
this=day.of 20Z by this day ot 20Zby
(Name of p r n c4 o I i (Name of per n "� ,dging) ANGELA M HUFF
NGELA FF . ;ms's_ Notary Public-Sate f Flori
Notar u .St to t Flo a iN. :rr co on# F 473
. m is on rk po, Co m• x 'res
(Signature f�,j ti L`- ?'Fq$ Signature o otaryAss
Bonded.through National Nntary Assn
Personally Known OR Produced Identifi tion Personally Known OR Produced Identification: l�
Type of Iden ' cation Type of Identification 'n
Produced �^ \C��- � duced r'��'p c' 'k/t, \
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW _ REVIEW
DATE
RECEIVED
DATE
COMPLETED
:Fe—v.