HomeMy WebLinkAboutBuilding Permit Application 09-17-15;02:04 ;From: To:7724621578 ;7724618722 # 2/ 4
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVE®
Building Permit Application
Planning and DevelopmentServices SEP 17 �0�5
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1653 Fax:(772)462-1578 Commercial� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line//
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Legal Description: 64A 7r k 4!�i 74C�.
Property Tax ID#:,1!�6 3 S~D A 4 0 Lot No.
Site Plan Name: Block No._____.....
Project Name: , p0 li'l ..,.•. _
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AC[Clitional wor ae e orme under is permit—c ec a appy:
&VAC []GasTank E]Gas Piping _Shutters Windows/Doors
Electric1:1 Plumbing ❑Sprinklers ❑Generator Roof
Total Sq.Ft of Construction: So.Ft.of First Floor:
Cost of Construction:$._.Z7 Utilities:0Sewer ElSeptic Building Height:,-
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Na a -�� �. fl ■ �clt- ',.Name: _
Address:5:DoS- M,5t ¢ Com any:"
City: -f~'_fr�.l:P. Cr�,,,,,,,.,,,,,_ State: ! Address;,' t` ,
Zi Code: QK
ZIP e Fax: City: 'r =., State:-E—I.
'•• JlJ'' lig:i(•
Phone No. S 749 t+o Zip Cade: =• � •: { Fax: 'ala Y40.1-
E-Mail:
40.l
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E-Mail: Phone No. �� u I_e_l O 7 l
Fill in fee simple Title Holder on next page(if different E-Mail: (e���
from the owner listed above) State or County License: JA 136
09-17-15;04; 34 ;From: To:4621578 ;7724618722 # 4/ 4
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DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY: of Applicable
Name: Name,
Address: Address:
City: ____.__-- State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COiVIPANY: t Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip:..----------.._..._--Phone:
I certlfythat 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 concurrrency 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
commencin work or recording: our Notice of Commencement.
s
_Signature of Owner/Lessee/Agent lgnature•of Contractor/License Holder
i
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF u, �-� . .--- COUNTY OF
The forgoing instruent was acknowledged before me The forgoing instrument was acknowledged before me
this day of V,�— 20 (,5_by this day of .20 by
vhw e S --
(Name of person acknowledging) (Name of person acknowledging)
7Fature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known �R Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No. (Seal)'
,�r►°y P`v',, 5A DRA HdHMANN
Notary Public-State of Florida
-.• My Comm.1:10M
Revised 07/15/2014. '° ,f Commission#FF 071660
goridOd Thiou9h Nailonat Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE