HomeMy WebLinkAboutBuilding Permit Application ppLICABLE INFO MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date: / Permit Number.
Building permit Application
Planning and Development Services
Building and Code Regulation division }
2300 Virginia Avenue,Fort Pierce F4 34982
Phone:(772)462-1553 Fax:(772.)462-2578 Commercial� Residential Y
PI=KNIT APPLICATION FOR:
Address:
Legal Description-
Pro perty
escription:Property rax ID#: r,?/,?:u_dZ GaJ-,J� Lot No.�
Site Plan Name: Block No.
Project Name.
Setbacks Front Back: Right Side: Left Side:
7
*I
7"Onao to ape rme under this perm –cheCK all tar appy:
echanical —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:$_ 5w 4° Utilities: Sewer _Septic Building Height:
Name 16&it/Yi.� IV, game: &rt[5 S"M S
Address: D. _ 02' Company: _Cus re:& At*(- S+ems
City: _ _ izz�/� e Stater• Address: lfe 15 S Vi 1 k dA_Q tt br
Zip Code: ,fit'�.�''! Fax: City. Vpp--t 5-C tie; d 0State: FL.
Phone No. 3 `i' 6' Zip Code: 9, 2 Fax
E-Mail: Phone No. '7 7, S
"i 1 in fee simple Title Holder an next page(if different E-Mail: e--u staL,r su t %7 -CL c 1-r.M
from the Omer listed above) State or County License: CAC 0 S 18 to -S-6LU
If value of construction is Z%fWar more,a RECORDED Notice of Commencement is required.
7��D
RDESIGNNERIIENGINEER: Not Applicable MORTGAGE COMPANY: ..__Not Applicable
Name: Name:
Address: Address:
City: Mate: 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 prier to the issuance of a permix.
5t.Lucie Count,,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 Nome 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 Suildog Codes and St.Luder 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 fiat 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/Agent/lessee Signature of Contractor/License Holder
STATE Of FLORIDA STATE OF FLORIDA
COUNTY OF '5-T L�v C l e COUNTY OF,-.
The for oing instru ent was acknowledged before me The far Ding instrLiment was acknowledged before me
this day of — .,2015 by this day of .20J
#din m or1C; — t� TCSfia C..._
(Name of person acknowledging) (Name of person acknowledging)
�
(Signature of Notary Public-Sta of Florida) (Signature of Notary Public-State of rida)
Personally Known✓OR Produced identification Personally Known " OR Produced identification
Type of Identification Produced_ .'Ay p„- ..Rwga E" Type of identification Produced
-�v..^a z; --lilY CQhIW16810N � tt,10 r6
Commission No. � ���y **.ao
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RMEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLMD
-lRev. 772014