HomeMy WebLinkAboutBuilding Permit Application ..pPLICAsLE INFO MUST`BE COMPLETED FOR APPUCAMOKTO BE ACCEPTED
`date: / 'a.S" Permit Number.
RECEIVED JUL 23 2015
Building" Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Wrginitr Avenue,fort Pierce FL 34982
Phone:(772)462-1553 Fax:(7n)462-1578 Commercial Residential
PERMtTAPPLICATION FOR:
Address 'W,7
Legal Description:
Property Tax tb#: 3M 1-Pl -f` ,I. 0d 6 `� Lot No.�__�__,.____.
11
Site Plan Name: Block No._-
II
Project Name:
Setbacks Front Back: Right Side: ��.Left Side.
Additionalworktotiepelffned un er is perm -»c l'c all that appy:
Mechanical Cas Tank Gas Piping —Shutters Shutters +Windows/Doors
—Electric _Plumbing __ Sprinklers —Generator Roof
'dotal Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction.$ �4//35 Utilities: _Sewer Septic Building Height:..
Name 4 , ' Name: &Ar ck S o
Address & 7, ".� � Company;
city: _pl a 160, _ State: Address: t 4 t 5 S9.
i .
Zip Code: -a�/?l'� Fax: City. �D '[ T Ltt C� State: 1.•
Phone No. Zip Code: 34M Fax: `7% 32 1 48-
E-Mail: Phone No. [7 x3,5' ~3a3-L
Fill in fee simple Title Holder on next page(if different E-Mail: cu et,q r %!4 a g c 01 r .
from the Owner listed abmm) State or County i_icense: C 051„R IQ 5'6t4?-
If
' 4?-If value of eonsMetion is2$War more,a RECORDED Notice of Commencement is required.
DESiGNWENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: — _Phone-, Zip: Phond:
FEE SiMPLE TITLE HOLDER: _Not Applicable' ROIIIDING COMPANY: Not Applicable
Name% Name:
Address: Address:
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 the ermit holder to build the subject structure
which is in conflict with any applicable Nome Owners Association rules,bylaws or an covenants that may,restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed r 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 guildiyg 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 faildre to Record a Nonce 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'- _ L_V C e _ COUNTY OF; S r Lia C.r_ C�.-
The forgoing instrument was acknowledged before me the forgoing inqt
eni was acknowledged before me
this-_ ?'day of 20�� by 'this.�day of 20LI by
CUr �-t5 ��•m1'1'1G/15 t��'�rs o�J¢mmrrn S-. _
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Sta of Florida) (Signature of Notary Public-State of06rlda)
Personally Known V OR Produced identification Personally Known OR Produced identification .
Type of Identification Produced AkW POA, CHUM n rg It l Type of Identification Produced
I[1f SOH#EE
Commission No. � ,�SEXPiRE5:Ap►fl4,801? Comrnisslon No.AgEe3fd/fi t ~ �$.
-1VU 9adedSfknBu tFkgnl * QRlEE
a 141 EXP
IRES:Apd4,201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
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COMPLETED
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