HomeMy WebLinkAboutBuilding Permit Application ,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATIOKTO BE ACCEPTED _
Date: �''��- permit Number:
RECEIVED
Building Permit Appiication AUG 2 7 2015
Planning and Development STervices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 3498
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residentiai
PERMIT APPLICATION FOR:
Address: -Av/ `xill-I-
Legal Description:
Property Tax ID#: ,�-112r,X0620C -7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front _ Back: Right Side: Left Side:
L llc� 1''pr c.lk� �� 3 �rc� Cid-�risG a-�'
ZD �l✓
1111 Mijanaor to be performed unclert s perms -MOCK all that appy:
—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:$ 1 2 p "J Utilities: _Sewer _Septic Building Height:
Name r/InoM.y §' C'aA,enName: Curb's .$d.my—non S
Address. &�— Company: K --L'r r
City: &ea r-1 SAddress: 15 S T i I a Ae.Q r& �r -
0 tri
Zip Code: NAL /,f w-1 Fax:T _ City: yo -t i State:EL.
Phone No. Zip lode: Q Fax: '7 , . 1 (,
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail- C Sfics r sU 9- 'OX 7 c a
from the owner listed above) State or County License: CAM,
if value of construction is256Tor more,a RECORDED Notice of Commencement is required.
DESIGN ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Narne:
Address: Address: -
Cl State: City.
Zip,., -. Phone: xp. Phone:
FE IMPU TME HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Addrew.
City: may;
Zip:_. Phone.
Z.
Phone:
OWNER/CONTRACTOR AFFIDYIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I c@r ft that no work or installation bas commenced prior to the issuance of a permit. }
St.Lucie County makes no representation that is granting a permit will authorize thermit holder to build the subject svvcture
which is in conflict with any applicable Home Owners Association rules,bylaws or ancovenants that may restrict or p ibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the grarnting of this requested permit,i do hereby agree that I will,in all respk ts,perform the work
in accordance with the approved plans„the Florida Buildivo Codes and 5t.Lune County Amendments.
:Me following building permit applications are exempt from undergoing a full concurrency review.-room additions,
accessory structures,swwimming pools,fences,wells,signs,screen rooms and accessory user to another non-residential use
WARNING M OMER:Your faiiare to Record a Notice of Commencement may result in your p2ong twice for
imrovements to your property.A Notice of Commencement must be recorded and posted on the jobsite
be the first inspection.if you intend to obtain fcnandng,consult with leader or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Agent/Lessee Signatur?of ContractorfUcense Holder
STATE OF FLORIDA SPATE OF FLORIDA
COUNTY OF , r L V C t e COUNTY OF; 51' e
Yrs
The forgoing Instrument was acknowledged before me The forgoing instrument was acknowledged before me
this &'day of��.G .20�by this day of .28 by
(Name of person acknowledging) (Name of person acknowledging)
(signature of Notary Public-S of Florida) (Signature of Notary Public-State of rida)
Personally Known V OR Produced Identification Personally Known ' OR Produced Identification _
Type of Identification Produced_. ,,w a An Hi Type of Identlfication Produced
Commisslon No. ��� t}�gpl tl�t,s017 Commission No.goer tip * SEE
�►������eeitlast►raAodp�tflafry . EXPiRE$:lyhg4,20!
44
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COUNTER REVIEW REVIEW REVIEW REViEW REViEW REVIEW
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