HomeMy WebLinkAboutBuilding Permit Application h.
,,PLICABLE iNF6 MUST BE COMPLETED FOR APPLICATIOtITO BE ACCEPTED —;
Date: e lS Permit Number — 1
. fes' � �
RECEIVED
Building Permit ,Application SEP 3 0 2015
Planning and Development Services
Building end Code Regulation Division j
2300 Virginia Avenue,Fort Pierce FL 3490' V/
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: � rfltl 1
Legal Description:
Property Tax ID#: ����+/ �G? 7 �1� �o�-�• tat No,
Site Plan Name: Block No.
Project Name-
Setbacks Front_ __ _ _ Back: Right Side: Left Side:
�l��e �z-,�r �..r'l'��- ,2-i'^✓� !���tt' j',.'hR+�S G 0'�/�,
rt na work to be pertormed tinder this perms --check 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:$ 7 Utilities: Sewer _Septic Building Height:
Name , Name: Cubs S0.k mon.5
Address: V914�* r v Company: QA -ro m ('Y i r ms- Q c,__
City:_,,&Z �+Q. 2r-�-� State: A�- Address: t1 I S�- `J1 r&N Dr -
Zip Code: +�Y 's"G? Fax: City: �g�T L4 C state: �.
Phone No, t?1:0Zip Code: Fax: 77; 335 l -4 L
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: c sto jr s� , p ao
from the Owner listed above) State or County License: CAC 0 S JR/0 - 5
If value of construction Is,2SWor more,a RECORDED Notice of Commencement is required.
7 gra
DESIGNER/ENGiNEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name. Name:
Address: Address:
City: State: City: State:
Zip: Phone. Zip: Phone:
FEE SIMPLE TITLE HOLDER: r�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 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
commencin work or recorftg your Notice of Commencement.
Signature of owner/AgentIlLessee Signature of Contractor License Holder
STATE OF FLORIDAtrGGG�L STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrume t was acknowledged before me The forgoing instru nt was acknowledged before me
this�day of�� 20�.by this&d day ofAe 26 by
(Name of person acknowledging) .(Name of person acknowledging)
c"
'(Signature of Notary Pu lic-S a of Florida (SignXture of Notary PPLiblic-Sta of Flotida}
Personally Known "_ _OR Produced Identification_ Personally Known. OR Produced identification_
Type of IdentH`ication Produced" a� +T;'�, rsao amac a ���6N Type of identification Produced
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to
MY C4MNl1S$!{}N A EE "��" CHIiI8TtN1:B.ENC3LISH
Commission No. �lal) EXNnES:ApiiI4,E017 Commission Na. d i�c �.., *. ..� S bkf�it9SiQN�E�85sr a
00004Thm6ndomitryB g, P1liES:Aprii4,201?
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REVIEWS FRONT ZONING. , SUPERVISOR . PLANS VEGETATION SERI TURTLE MANGROVE
COUNTER REVIEW REVIEW RE�IiEW REVIEW REVIEW .. REVIEW
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