HomeMy WebLinkAboutBuilding Permit Application ,PPUCABLE INFO MUST RE COMPLETED FOR A PPLICATIOIW TO BE ACCEPTED /
Date- 1 Permit Number:
II
RECEIVED
Building Permit Application JUL 12 2 15
Planning and Developmentserviees
Building and Cade Regulation Division "
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-2553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description,
Property Tax ID#: ` �- r'1(--'5 6Zt.a'7 000 - 1 Lot No.�
Site flan Name: Block No.
Project Name:
Setbacks Front.._ Back: Right Side:_Luft Side:
Additionalwork beperformedunderthis permit-crieckan that appy:
_Mechanical _Gas Tank _Gas Piping Shutters —Windows/Doors
Electric _plumbing _Sprinklers —Generator _Roof
Total Sq,lit of Construction: _ Sq.Ft,of First Floor:
Cost of Construction:$.. utilities: _Sewer �Septic Building Height:
Name,alit i !-AeI'P.yL-0_ .5 7 4' - Name: Curt(-5 S=mon.5
Address; 51.11 QQ e_ C*- Company: c-r,,&Air� i S efM5 I&C.
city: tsxal State; f.,=�.... Address: 1-5-
Zip
5Zip Code: 314R5a __ Fax; City: ffi-e 5T Lucie- state:' L•
Phone No. Zip Code: ' Fax 77.1 335 )i
-�MiY rMV
E-mail: Phone No.
Fill in fee simple Title Molder on next page(If different E-Mail: C.Ifi W 1;u(.3 mC&P 1'r c t `
from the Owner listed above) State or County license: CIA C 0 5 i R 10
If value of construtUon is?.sWor more,a RECOIWED Notice of Commencement is required.
7
v
DESIGNE ENGINEER; �Nat Applicable Mt R-T-GAGE COMPANY: Not Applicable
Name- Name:
Address: Address:
City. $tate: �_ City: State:
Zip: Phone: Zip:—' '. Pbond:
FEE SIMPLE TrrLE HOLDER: � Not Applicable 56NDING COMPANY: Not Applicable
Name% Name:
Address. Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFiDV'IT: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.Lucle Counter makes no represen tion that is granting apermit will authorize the permit holder to build the subject structure
which is In conflflict with any applicable Home Owners Association rul ,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 Buildipg Codes and 5t.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additlons,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessary 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 jobsiter
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
commencing worts or recording our Notice of Commencement.
Signature of towner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S 7 L U CI a COUNTY Of e5'Y' L✓ t•r
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of .20 by 'this�,r day of .20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-sta of Florida) (Signature of Notary Public-State o rida)
Personally Known OR Produced identification Personally Known '� OR Produced Identification
Type of identification Produced Y CNOType of Idenftation Produced
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���S�.�y' itiYC,4IIw1ili81ti�1 i�E .,��;:••.
commission No. * ) I:ItPIAlc8tApt��,2417 commission No. [ /s7r1r
'+}� eaid�dThN94d41tGofK! * #�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER RWIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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