HomeMy WebLinkAboutBuilding Permit Application t
,PPLICAdLE INFO MUST BE COMPLETED FOR APPLICA11ON TO BE ACCEPTED
'Date; Number: 50
1 oy3o
RECEIV*7D JUL 2 9-1015
Building Permit Application
Planning ar d Development services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982'
Phone:(772)462-1553 Fax: (772)462-7.578 Commercial ResidentialV-i
PERMIT APPLICATION FOR: �L
Address:
Legal Description:
Property Tax ID#: I .I 0"d ece) Lot No.
Site Plan Name: Black No.
Project Name-
Setbacks Front Back: Right Side:—Left Side;
vice L./ Trrxhe� z., If fj'lrl
4
W7tnaora pe rme un er t �s pem, –c ec a at app y-
_Mechanical W Gas Tank `Gas Piping _Shutters Windows/Doors
—Electric —Plumbing _Sprinklers _Generator 4 _Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$_ d0_. ., Utilities: —Sewer _Septic Building Height:
Name dos>4h d g&M iCia Name: C trtci �r_Wmign S .
Address: S ��i.n Ise- lr Company:_Cio -& t_L. _1i i_r &_S+e- S )ru C.
City: 1oQr 54 Lk,-ig. _ State: -F2- Address: 15 S E `U i I(QqL r�
Zip Code: vl $3 Fax: City- ga 5T_L4C«. __ State: R,
Phone No. Zip Code: 34 5&b Fax. '77A J,� ig44a
E-Mail: Phone No. __..._. 77�... 3�5..�3232
Fill In fee simple Title bolder on next page(if different E-Mail: v c o)_.c
from the Owner listed above) State or County License: Cfl C 0 S l S I D - 54cLkQ- ' _
If value of construction is2SWor more,a RECORDED Notice of Commencement Is required.
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w�1,111 .�i�,���i�moi!iY�� �i�lY����.��11 �iilil•�,�I��S
DESIGNE >rNCINV R: Not Applicable MQRTGAGE COMk�ANY: „Not Applicable
Name: Name: '
Address: address:
City: State: Ci _ ' State:
Zip: Phone: Zip: ,. Phone
PEE SIMPLE TITLE MOLDER, Not Applicable ID611DING 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 certiPj that no work or installation has commenced prior to the Issuance of a permit.
St.Lucie Countymakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which Is In conflict with any applicable Horne Owners Assouation 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,perforin the work
in accordance with the approved plans,the Florida BuiWQg 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 paging twice for
introvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
be ore the first inspection.If you intend to obtain financing, consult with lender or an attorney befi re
commencing work or recording your Notice of Commencement_
Signature of owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF.. � COUNTY OF-L, 6-I' (frLa r� -
The fo 'ping instr ent was acknowledged before me The forgoing inst en# es acknowledged afore me
this„�day of ,26 + by this day of 26.J_ by
(tame of person acknowledging) (Name of person acknowledging)
f'1/y�'•^7�'' iI ILIA •"`
(Signature of Notary Public-Stat0of Florida) (Signature of Notary Public-State of rids)
Personally Known OR Produced identification Personally Known OR Produced Identification„
Type of Identification Produced ,---.W aw,,. 8"Iffii Type of identification Produced
Commission No. sQ4y * �INYCOb " 'ur�aZa c tl�a
) EXP;REB:Aps1#,2047 Commission No. * #
4—1w eadrdtka tNdasr EXFIgF3.Apn1t,2lt!
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW. REVIEW RCVIEW REVIEW REVIEW
DATE
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DACE
COMPLETED
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