HomeMy WebLinkAboutBuilding Permit Application 06M; Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division R E C E I V7D OCT 0 6 2015
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax;(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, cljO arrow at the end of line VkV A(Z-
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Address:....
Legal Description:
Property Tax ID#:.,. q'1 0 0(D 15-0 a)y Lot No.
Site Plan Name:. XiYilr Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Shutters Owinclows/Doors
Electric Plumbing Sprinklers Roof
rT— M 1:1 Generator El
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction: Utilities:0Sewer❑septic Building Height:
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Name_t/J0/ "N
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Address: 14.41 -re- % com.pan.V:
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Cit _ staterress: zz�'C'4. J
;;Zip Code: Fax: City: 110) #9 State:
Phone No.
Zip Code: Fa
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E-mail: Phone No.
Fill in fee simple Title Holder on next page if different E-Mail: 9A_pt 42.,14 CZ
from the owner listed above) State or County
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
:W0JJ" ct: WSL-90-N
10-05-15;21 :43 ;From: To:4621578 ;7724618722 # 2/ 8
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: __ State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: of Applicable
Name: Name:
Address: Address:
City: 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 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,1 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 OWNED: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
commencing work or recording our Notice of Commencement.
5
�gnature of Owner/Lessee/Agent 101ature of Contractor/License Holder
ApFORIDA. �e oNTQRIDA,�/QuTY OSTATE
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The fo going instr me t was acknowledged before me The forgoing instrument!_was acknowledged before me
this day of G7O� 24/„V_by this A day of Z Gkh4g .zo /fir,,,,by
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(Name of person acknowledging) (Name of person acknowledging)
JoAdlo_ 401�00_tA___ - NJ11W11dZa_1/40AZ��
(Si ature of Notary Public-State of Florida} (Sig tore of Notary Public-State of Florida)
Personally Known `tel OR Produced Identification Personally Known L---OR Produced Identification_„
Type of Identification Produced Type of identification Produced
Commission No, +�:p�p� al SANDRA Seal
-a7� 1 ,horn slon No. (Seal)
,A Notary Public-State o �lorlda SANDRA NOHMANN
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My Comm.Expires Mar 14,2018 ���1 ��%
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+� " My Comm.Expires Mar 14FY ruolic-.$rate of ,Zol
Revised 07/1S/2014
Bonded mroughNational Notary Assn, ,�
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MAG 0
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DATE
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