HomeMy WebLinkAboutBuilding Permit Application ALL APP.LICARLIF INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date:° f .'{ Permit Number_ 1 5 °
RECEIV'D AUG 241015
Building Permit'Application
Planning and Development Services H 11�p RM
Building and Code Regulation Division
2300 Virginia Avende,Fort Pierce FL 34982
Phone:(772)452-1553 Fax:(772)462-1-578 Commercial Residential .
PERMIT APPLICATION FOR: Other 1 �� �C'
MEN
Address:
Legal Description: slrznd �� ml�r•�vrr>`►�� l
Property Tax ID#: Lot No.,_
Site Plan Name: Block No.
Project Name,
Setbacks Front Back; Right Side: Left Side:
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UVj
i
HI to a wor a e 'e rme un er t is perm —c ec a appy:
VAC Gas Tank E]Gas Piping Shutters ❑Windows/Doors
1:1Elearic U Plumbing Sprinklers OGenerator Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ A5Z Utilities Sewer Septic Building Height'—
IMP=
Name �� 10 Name: PYl
Address: Company: a �
City: '' State:� Address: 102
Zip Code:jJJ 40 - Fax• City: � _ tate
Phone No. Zip Code' Fax IN
E-Mail.• Phone No.
Fill In fee simple Title Holder on next page(if different E-Mail: iffy
from th-e Owner listed above) state or ounfticen�se: ���
if value of construction Ij$z300 or roars,a RECORDED Notice of commencement U required.
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F7rDCS16N8MVE1N40INEFR._* V Not Applicable MORTGAGE COMPANY: Not Applicable
Name* Name:
Address:
Address.
City: State: City:
Zip: Phone: Zip, Phone:
FEE SIMPLE TITLE HOLDER. I/Not Applicable BONDING COMPANY., Not Applicable
Name: Name:—I
Address: Address:
City; City;
7-1p: Phone: Zip: Phone:
I certify that no work or'Ji-istallatlon has commenced prior to the issuance of a permit.
St.LL
which is Counjimakes no representation that is granting a permit will-authorizI6 the permit holder*zo build-the subject structure
ln:con, ct with arly-applicable-Home Owners Associatlon 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 f Will,In all respects,perform the work
In accordance With the approved plans,the Florida Building Codes and St,Lucie County Amendments.
The following b6ildinig permit applications are exempt from undergoing a full concurrericy review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING70 OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
len rottetnents 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
ccirriTnencihg Work or recording Vour Notice of Commencement.
L
14MM _tor/License Holder
STATE OF FLORt y STATE OF FLORI
COUNTY OF. COUNTY.OF
The Ing instr mntwasacknowledgej_�efore me The f;or ping ent was acknowledged bef9re me
this day of 9 A� day of IKIUJQU�� 20,
qAjL6± 20 Itibiy this by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) 7 r (Signature of Notary Pubic-State of Florida)
Personally Known_ZQR Produced Ident!flication Personally Known OR R Produced Identifickion
Type of Identification Produced Type of Identification Produced
Commission CRY8`TAtS&"F_VED0
17my'
aft-ft—Iseall 1 1 Commission No.
CRYST 117 COMMISSION#FF:004048
AL A Quiqii6l
1�wk�!!T
CRYSTAL!
EXPI IN 3
Revised 0 P E*IRES July 31.2010
REViEWS FRONT ZONING VEGETATION SEA TURTLE MANGROVE
DATE FRONT ZONING
S URPV REVIEW REVIEW REVIEW
COMPLETE
INITIALS
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