HomeMy WebLinkAboutBuilding Permit Application 09/03/2015 12:05 FAX 2001/003
ALL APPLICABLE iNF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: . Permit Number: �j C�
RECEt�`�D SEP O ZOaS
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34382
Phone:(772)4624553 Fax: (772)462-1578 CommOrciaf Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line `
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Address:-"r`�{iC% %l� 1-I-�a 1,t s r ui �l En-r =sr rf i'•t t�C'=F �>;c f C: Y" ',''t`��t i-�Gl
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Property Tax ID#:—L'IS- ;,i t"- czo- cceC Lot No.
Site Plan Name: Stock No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
tn.J ,��i r 1 r'.[:-' L...'J.f".�:f.��.4,.T t.;r ;"'•i f'}'i It�``/ �Lam.J"J. C�l%S r.':.`J" 4..4� �„
itiona wor to e e orme un err �s permit—c eck all that apply:
QHVAC Cas Tank ❑Gas Piping _Shutters Windows/Doors
Electric L, 'Plumbing �Sprinkiers FI Generator Roof
Total Sq. Ft of Construction: 5 Ft.of First Floor:
Cost of Construction:$ �_moi' Utilities'. Sewer F]Septic Building Height:
7City: L,//
ct,�.. ��IL�� �C Name: o
fG�C1 l ir% r/ L . ?/% 7f� Company: -C �� t.hr. 1�n V1sn
' '� .�Wit_ State: f�c Address: l W v�c'k• V
Zip Code: ;S(�' — Fax: City: VU t-�- S'l'.LA&. ,,L State: l.
Phone No. —7 7. 2 — ./%. .> zip Code: - °m QA4 Fax:-J:]-I, JN 010b)l
E-Mail: Phone No. 011 civi
Fill in fee simple Title Holder on next page(if different 'E-Mail. aun �►rt. �vun {,cvh-�
from the Owner listed above) State or County License: Cs; 1`1k;W 1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
09/03/2015 12:06 FAX 1a002/003
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DESIGNER/ENGINEER: _ Not Applicable ta
ORTGAGE COMPANY: _Not Applicable
Name: me:
Address: Address:
City: State: :City: State:
Zip: Phone: !Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable !BONDING COMPANY: Not Applicable
Name: Name:
Address: Mess:
City:
Zip: Phone: Zip: Phone:
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 ryles,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 an ed on the jobsite
before a first inspection. If�Our
d to obtain financing,consult with lender torney before
comm cin work or recotice of Commenceme. _
OF
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gnatur` of Owner)Ag n 'Lesseegnature o Gvntractoi�/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledaPri before me ?he forgoing instrum7t wa knowledged before me
this�T day of .7015-by this_ day of�{i a0/:S by
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(Name of person acknowledging) (Name of person acknowledging)
(Sign of Notary Pu " - tate rlorida) (Sig natu Not:��PVZEIPAYA_
Public- a)
Personally Known dIdentification Personally Known�
Type of ldentificatio PFOOUC,e<d . ES' , r Zr,_A i Type of Identification Produced: ,
EXPIRES(SUct ber 1,2018
Commission No. N . ;' MY C20JON#FFt65172 Commission No. N ea
XPII October 1,2018 e•!-A$3 Florida atary etvice.com
407 388.0153 Floridallota Service.com
Revised 07/15/2014
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