HomeMy WebLinkAboutBuilding Permit Application I APPLICABLE INFO,MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
Date: Permit Number: � �• `f
CP
Building Permit Application
Planning and Development services JUL 0..9 .2015
Building and Code Regulation Division
PERItlff"f.r
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential St te- `: `"_r
PERMIT APPLICATION FOR:
MEN
Address: &DC&O v----
Legal Description: _C—,Jcfu C� �Q (A
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: 10 Left Side: 10
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Additional work to be performed under this permit-check all that 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: 3�-
O O . 00 Utilities: Sewer 1
Cost of Construction:$ t-ty /Septic Building Height:_ Q�
IME11"M=11
Name .PAO a_\,ct.L 'Name:. plc.. t M1•O _�U(3G-2Sye� _
Address: 81006 LA k_:C;a (I JhLyD Company:
City: Fntin- PI C-At,(s Stater- Address: 17,lu '°1!, lr Qxf irn (01I (jLyQ
Zip Code: !34 T 1 Fax: City: L?,o(2=Sr—# Ctj" (- State:�L
Phone No. Zip Code: ? Fax:
E-Mail: Phone No 94?- - ?_- - L4a4S
Fill in fee simple Title Holder on next page(if different E-Mail SEe,(A i M L (0, !JA-rtV0
from the Owner listed above) State or County License G6e. 15147--llo
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 thepermit 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.
Signat re of Owner/Lessee/Agent Sign atur of.Contractor/License Holder
STATE OF FLORIDA STATE OF,FLORIQA
COUNTY OF GP t.¢, COUNTY,OF U - _UC.tle
The forgoing instrument was acknowledged before me _ The forgoing instrument was acknowledged before me
this day-of ZXLD., 20by thisday of y .20_,�by
A(Naffim ' son acknowledging) (Name of person acknowledging)
(Signa ure.of Notary Public- to of Florida) (Signature of otary Public-State of Florida)
Personally Known du I6{{QI8ARAM 'Personally Known OR Produced Identification..
Type of Identification o ary Public-State El Florida Type of Identification
fo '�_My.Comm.Expires Dec 20,2018 Produced �� IUTRINA D.HUBB
Produced p,:
�.,F,,.;,, ,. mission#FF 177249 a e
Notary Public,State of r a
Bonded�br�il nNa(ionai.VotaryAssn• mmission#fE
Commission No. F - (Sea Commission No. eal
My comm.expires Mar.2 , 17
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
-COMPLETED
ev. 712014