HomeMy WebLinkAboutBuilding Permit Application .PPLICABLE INFO MUST BE COMPLETED FOR APPLICATIOITTO BE ACCEPTED
Date 1,5 Permit Number:
RECEIVE
�DAUG 0 1205
Building' Permit Application
Planning and Development services I I
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 3498 '
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: �C_
Address:-- -/0&00 01eeeoLe�'bee f4d
Legal Description.
Property Tax ID#: 4 5'Z Of-4 C Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back- Right Side: Left Side.,
Adclitionalwo-Ito-bape orate d Under this permit-checkali that apply:
—Mechanical Gas Tank Gas Piping —Shutters Windows/Doors
Electric Plumbing Sprinklers —Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: Utilities: —Sewer _Septic Building Height:
Name Gb0e-'skQ- Name. OLLCLIS So
m Yn an
Address:-Lb�oC> n-tecam'L- Company: Air &- Sfe(Ms )Ajc
i
City:-a'(-i' eor el State:tom[-- Address- 1�15 Ti .1 e. rery
Zip Code: SLAC�I- ! Fax;`fit - City: pek'T ST LJkL1;e_ State; r1-
�
Phone No. (�)- �9Zip Code:...-.14�'_Vj Fax: .'ID MY )2�N—
E-Mail: Phone No. - 172 336 -30-311
Fill in fee simple Title Holder an next page If different E-Mail, g-tj sta-1 y
- cg
from the Owner listed above) State or County License- C 0 t5 19 0 -
If value of construction ls25eCror more,a RECORDED Notice of Commencement Is required.
Q lGNE ENGINEER: Not Applic$bie MORTGAGE COMPANY: —Not Applicable
Name: Name:
Address: Address:
City: _ - State: City: State:
Zip: Phone: Zip: Phond:
FEE SIMPLIE TITLE HOLDER: _Not Applicable 06NDINO 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.
1 certify that no work or installation has commenced prior to the issuance of a permit.
-w
St,_ cie County mak no rept entation that is granting a,permit will authorize the permit holder to build the subject structure
whri Is in conflict wrn any app Icable Home C1wr�ers Association rules,bylaws gr 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 respedts,perform the work
in accordance with the approved plans„the Florida Buildipg Codes and St.Lucie County Amendments.
-rhe 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 Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posited on the jobsite
before the first inspection. If you intend to obtain financing consult with lender or an attorney before
commencin 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 S7 L-U C i,e COUNTY OF.;.. 5-r L,L) t i e
The forgoing instrument was acknowledged before me The forgoing Instrument was acknowledged before me
this,W,-,.day of 20_ by this_,T day of .20_ by
Ourfrs S*mm6r'15 CUATrs 0541"Man K_
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-StaWof Florida) (Signature of Notary Public-State rida)
Personally Known OR Produced identification Personally Known '� OR Produced Identification_..
Type of Identification Produced - L e Type of identification Produced
Commission No. 2017 Commission No. " -�Syd�y
�� ) EXPIRES:A 4, * 111'C01Nl�IGNa11�
`°�,m� emeedThru9u4p�llahry eay dS:Apra�,2b}
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REViEW REVIEW REVIEW REVIEW REVIEW
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