HomeMy WebLinkAboutBuilding Permit Application ,,PUCABLE INFO MUST BE COMPLETED FOR APPLICATIOtiTO BE ACCEPTED
,Date: ;e_ /''� Permit Number: /�0 — 0
RECEIVED
Building Permit Application JUL 21 2015
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description;
Property Tax ID#: ���5 -'��!" �O�7"� " Lot No,–
Site Plan Name: Block No.
Project Name:
Setbacks f=ront Back: Right Side: Left Side:
f fie. �� LIlgc 'Ser( 6A MC, P-`'
FA
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Addlional work to be performe under this perm –chacK all that appy:
V/Mechanicai _Gas Tank _Gas Piping „shutters _windows/Doors
Electric _Plumbing Sprinklers _Generator _ Roof
Total Sq. Ft of Construction:p Sq.Ft.of First Floor:._
Cost of Construction:$ T 70 Utilities: T Sewer _Septic Building Height:
Name fila Name: Curf.ts -Saarnanz
Addre s: !l zl___
�-" azLl' __ Company: _A it jti fees-- A�u Q
city: State: AI AI Address: i� 15 S P, V i I l r
Zip Code: ad W Fax: City: 'POLI 5T Luc►C. State: EL,
Phone No. be��" �/5�,�/'�� -- _ Zip Code: 95 _ Fax: 'T7235'_19-4
E-Mail: Phone No. 773- _
S 3 .32
Fill in fee simple Title Halder an next page(if different E-Mail:___ Qa r M
from the Owner listed above) State or County License: CA C 0 " ? 1
if value of construction is26Wor more,a RECORDED Notice of Commencement is required.
Too
pn-�1111 NEW
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY- � Not Applicable
Name: Name:
Address: Address:
State: cty: State:
City: Phone:
Zip: _ _ Phone: Zip:.
FEE SiMPLE TITLEHOLDER: _„_,,,Not Applicable' BONDING COMPANY: Not Applicable
Name:, Name:
Address: Address:
City_ City:
Zip: Phone.• zip: Phone:
OWNER/CONTRACTOR AFFiDVI;T.Application is hereby made to obtain a permit to do thework and installation as indicated.
1 certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Courtt�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 auildipg 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
SPATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTYOF;
Thefor oing instr nt was acknowledged before me The forgoing instrument w acknowledged before me
this Wday of 26ZJ by -this—4 day of 2a y
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publio•Sta of Florida) (Signature of Notary Public-State of,06rida}
Personally Known V OR Produced identification Personally Known OR Produced Identification
Type of Identification Produced Af Type of Identification Produced
-- ' my commiSSION I R '`;� CFIRt�fliVl=Bl
Commission No. C �� * 1) EXPIRES:Apd14,2017 Commission NO. r ,5'�'dd°41 1 MYCp If&gI0NI1EE
"�or� eondeatiwuBudvettiatarS �� EXAIRS$-Jlpti14,21f1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEt1►t
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