HomeMy WebLinkAboutBuilding Permit Application /Ll1(o
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 4
Date: 7' Z -' Permit Number:3
RECEP. ':D JUL 311015 V.
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: �(� �✓�f' S�Oy!tf ®C9�1 �//l✓� '��i i;
Legal Description:
Property Tax ID#: I-0-11- 3l1-OD �y o a 0' Lot No.46
Site Plan-Name: Block No.
Project Name: L/1�IJ-TUP-�6- R;i;P3 1.R-
Setbacks Front Back: Right Side: Left Side: k
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rtiona wor to e e orme under tispermit-check all that appy:
❑HVAC Gas Tank Gas Piping Shutters Q Windows/Doors is
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Electric Plumbing Sprinklers a Generator Roof !=
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of construction:$ C/ 0-570® Utilities. Sewer F]Septic Building Height:
Namey-2:1- D 5CHM:IEv/ Name: �4 7H
Address:Z37 %�) Company:6--Ar4Ce-C(D C7AX4L
city: 1 /9-i��701--)n State:C%o Address:
Zip Code:0 67 93- Fax: City:���% ���� State:�� I`
Phone No. 765 , 7 � � Zip Code: � ��b� ttI1�� Fax: 7
E-MaiI:fGC�-7-WMD/AXU e-0 '/)W,C� Phone No.77Z 56�' 791
Fill in fee simple Title Holder on next page(if different E-Maii:'61'i/(-W® p- i
from the Owner listed above) State or County License: 1-001---C l-50 0 3 V15
to
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Lt/(Vot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: V"Not Applicable BONDING COMPANY: _ of Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
certify that no work or installation has commenced priorto the issuance of a permit.
St.Lucie Counter 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 i
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments. I
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 j.
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.
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_Signature of Owner/Lessee/Agent Signature of C tractor/License Holder
STATE OF FLO A ' " STATE OF F A
COUNTY OFLiULa(_('X. COUNTY OF � �-p 1
The forgping instrument Was acknowledged b fore me The for,g,o.{{�pg instrument was acknowledged before me
thlsay of 20/ by this (1 day of 20 by
�Auu,
(Name of persona nowledging) (Name of person acknowledging)
( ture of Notary Public-State of Florida} ature of Notary Public-State of Florida)
Personally Known e OR Produced Identification Personally Known�OR Produced Identification
t•o�S P o ced Type of ldentificati n Produced s
Type of Identifica � r du YP
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Commission No. :o. n �l n (( ea Commission No.
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my COhNItIS�IUt�'r�EE114196 - � 11i'(COMMISSION#EE114196
P ES October 11,2015 �''�o �a EXPIRE n
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D )390 0153 Florida Notary8ervlce.com (407)390.01.`.3 FlordallotaryService.com
Revised 07/15/2
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