HomeMy WebLinkAboutBuilding Permit Application ,PPLI CABLE INFO MUST BE COMPLETED FOR APPLICATI ON TO BE ACCEPTED
Date: r irl Permit Number:
.RECEIVED SEP 21 Z1115
13uilding• Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Port Pierce Ft 345$P
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: V
Address: -
Legal Description:
Property Tax ID#: ' 0"21 -15-ad ` qg-& Lot No•
Site Plan Name: Block No.
Project Name:
Setbacks Front __ Back: Right Side: Left Side:
RIW7ttnaorto a pe orme un er t is perm t-c ec a t at appy.
_ echanical _Gas Tank Gas Piping _Shutters Windows/Doors
_Electric Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq- Ft.of First Floor:
Cost of Construction;$ -3 Utilities: —Sewer _Septic Building Height:
Name Name: C.(xrtts 'S!&Mjvton•
Address; / !C/l(l o An 61 Company. CA,,:-rtom R i r SLi s fe f=I-N ce
City:�� .�. State: / Address: Jap'-a r N �r
Zip Code: df`� �. Fax:- -- City: Pc,rz'T 5T State: rL,
Phone No. J7P- 1/1 A?q Zip Code: 3495 Fax: 77�
E-Mail: Phone No. 3�3�.
Fill in fee simple Title Holder on next page{if different E-Mail: q9c.'o l c cin
from the Owner fisted above) State or County License: C41 C 0 5 181 D
If value of construction is25edor more,a RECORDED Notice of Commencement Is required.
7��0
WDSIGNE0 ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name;
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable 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 Count makes no representation that is granting a permit will authorize thepermitholder to build the subject structure
which is in con Pct with any applicable Nome Owners Association rules,bylaws or an covenants that may restrict or prohibit such
structure_Please consult with your Nome owners Association and review your deed for any restrictions which may apply.
Inconsideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the worts
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 a0d accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record 6 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
commencina work or.recor"it vour Notice of Commencement,
'Signature of Owner/Agent) see Signature of Contractor License Molder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �o C r ,:? COUNTY OF. ,�'� L Uc f e
The forgoing instrument was acknowledged before me The forgoing Instru e� as acknowledged before me
this�day of _ ,�20� �day oby this f.28Z.S by
�'rcc in m a n Curt,I's ,TA.,m M.on.s
(Name of person acknowledging) (Name of person acknowledging)
Signature of Notary Pub/lis-State Florida) (Signdture of Notary Public-State of Yida}
Personally Known V OR Produced Identification Personally Known � _ OR Produced Identification
Type of Identification Produced-., 'type of Identification Produced
p !AY Ptd
Commission No. ��a7 '""�•••' SItiiEfOMM15510NOEE8b9284 Commission No� O Lf�0f a¢`,•••••, a iR1ST1NEB.kT1QLISH
,� * OMMISSION 4 EE 869284
EXPIRES:Apti14,26 7 EXPIRES;April 4,2017
'� � gankd7te�t�petNtlt�y9at�scs ��" e* f
RI_tIIEWS FRONT ZONING-. SUPERVISOR- PLANS VEGETATION SEATURTLE MANGROVE 11
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETED -
-re-v. 772014