HomeMy WebLinkAboutBuilding Permit Application ,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date: Permit Nurnber:-/67ia
RECEIVED
Building Permit Application JUL 2 012015
Planning ai�d Development Services
Building and Code Regulotton Division
2300 Virginia Avenue,Fort Pierce FL 34992
Phone., (772)'462-1553 Far. (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR;
Address:
Legal Description:
Property Tax ID
Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back- Right Side- Left Side:
M A
zona rX to be pe rto under this permit–cnKK 511 that apply.lone 10
/Mechanical Gas Tank Gas Piping —Shutters Windows/Doors
—Electric Plumbing Sprinklers —Generator Roof
Total Sq.Ft of Construction: I Sq. Ft.of First Floor.
Cost of Construction:$ rzt
L Utilities: Sewer _Septic Building Height:
Name :nq 4(Leu s 4-N---6 M 3-fDA d 7,10 Name: CurtLs SgtAMO=1
Address;-,24- Sa426W".. Rd - company: C&m& AL &S+e, I )&Q
I
City: State:CT Address:- t415 'V I' I lajap-Q,rOCA Dr
Zip Code. 049 1t:50d state-E.
_ Fax: City: E6 em LU C t C-
Phone Na. - 903 �3 7 TOO 5 Zip Code- 311,Pi Fax: qJJ 33:"-1169
E-Mail: baciwk- sbrq 0-61, KA Phone No. 7:7,W.......
Fill In fee simple Titley Holder an next page If different E-Mail:
from the Owner lk-ted agave} State or County License: CACP 6)R/Q, 7--S'6-t4e--
If value of camtructlart Is2Wor more,a RECORDED Notice of Commencement Is required.
DESIGNER/ENGINEER; _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: T State:
Zip: Phone: zip: Phond:
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.
5t.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 Buildipg 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.
Signature of owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S 7' L-v C t-e COUNTY OF 5 Y LLP C I e
The forgoing instr ment was acknowledged before me The forgoing instpffnent was acknowledged before me
this ago day of 2Q_/S-by this day of ,20Arby
-- -
Ourfig J o+ motif cim7rs 054ml�7��rI C
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Sta of Florida) (Signature of Notary Public-State o..fad&ida)
Personally Known_�. OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced r P 9=8Type of Identification Produced
MWYCONJEE&M OY R
Commission No. �� sq� y *� 1) EXPIRES,ApM4,2017 Commission No.
�!go� eeneed ftBow fto►ary EXPIRES:Ap1114,201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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