HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ] 5 Permit Number:
RECEI Y'TD SEP 0 2 2015
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: (5 O� is �� r
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Address: Fo E
Le a1 Description: I ffA i n n \jr r t 1S— !
Property Tax ID#: 3' `� �� "�b3�— �6 "3 Lot No.�
Site Pian Name: t q, }-'LBlock No.
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Project Name: -i Y 11-ft,
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormecl uncler this permit-check a I th atapy:
Mechanical _Gas Tank Gas Piping Shutters ✓Windows/Doors
Electric Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor: I
Cost of Construction: $ �� I , Utilities: —Sewer _Septic Building Height: I
WOMAN,
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Name C �}V, Name:_.rybrvjAnna
Address: r� nn Prc;r�o�
” )�� -. =��1��� l�� Company: !YI'ti'f�rt�em{tse �" uarj dbr
City: 9 State: Address: 005 7om,&a,3V 'D,-
Zip
D,Zip Code: . ` FFa�x{:NLA _ City: ZrI4114n 14-zebat4l Qe'GGk State: Fl
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Phone No.�, 1Zip Code: 32937 Fax: 32_I- 777- qZ3 y
E-Mail:N/A Phone No. 772-337-zfy70
Fill in fee simple Title Holder on next page(if different E-Mail: Guess h uun c 4 ako.:�. taM
from the Owner listed above} State or County License: r J�
If vaiue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: city: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE,HOLDER: —NotApplicable BONDING 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 certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit 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
in accordance with the approved plans,the Florida Building 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 paying twice for
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
commencilig work or recording your Notice of Commencement.
Signature of Owner/Agenf/Lessee Signa-.--- of
Contractor/License-Holder
STATE OF FLOSTATE OF FLO
COUNTY OF COUNTY OF
Thef going instrumoent fw_ a/,.a9knowJ1.edged before me The fIffoing instr e i .acknowledged before me
this I Of .2(),IP5bv this C - 20D by
Zcla� Jayow(
mn es
(Nam er owl ging) 7(Nesqnackno fedging)*
Signa'6r-e-6f
Nqeaite of Florid (Sirrature o��fa IV§tate of Florida
Pe onally Known_OR Produced 1de tification Personally Known OR Produced Ideyrtification
Type f Identification Produced Type of Identificabo oduced—
ol
Commission ,anBROOmiss
My COMMISSION#FF 2440 " 83 En
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01 XPIRES,June 25,2^9
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REVIEWS FRONT --SUPEKVIS-OR PLANS VEGETATION SEA TU1v1A_17VyrTt7TT"�
COUNTER REVIEW" REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 1/Z014