HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: vzb Permit Number:
R CEl'.-D OCT 077015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34382 /
Phone: (772)462=1553 Fax: (772)462-1578 Commercial Residential J
PERMIT APPLICATION FOR: acX 0'.'P
Address: tv-( -P-t1'- firm IC(
Legal Description: �wL� ` 'ark-wni± 10- P51 rw Lt)+- 4 Lmap i�+s) br
Property Tax 1D#: �"�C'J 1 y a -� X343 4 GOO -cj Lot No. "I
Site Plan Name: Block No. 1'2D
Project Name:_Lclkz 15AICCI
Setbacks Front Back: Right Side: Left Side:
1rxslao hke Cor like c� ✓aa.2 &or
�tiona work to be pe orme under this permit-check all that appy:
Mechanical r Gas Tank i Gas Piping ^Shutters ✓Windows/Doors
Electric —Plumbing _Sprinklers ^Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Fc�Si�0- Utilities: —Sewer —Septic Building Height:
Name 4- Name:_ �
Address: 58 4-2 3 L-cLke i- Company: M01 E!L='rise aE xeuc�� �7c >'fec,sian
A*s
City: State: T�L Address: i108 "rorriahawk 'D,,.
Zip Code: �L z Fax. M City: lrv' nn }aebm, Ge.0n, State: F/
Phone No.t5tnj 252-�'7�� Zip Code: 32.93-7 Fax: 3Z1- 777- 1-123 y
E-Mail: 'A/ 4 Phone No. 772-337-111170
Fill in fee simple Title Holder on next page(if different E-Mail; i✓u{es5 uun shoo• c aril
from the Owner listed above) State or County License: j
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
im
DESIGNER/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 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 rn restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions may rhch 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
comm cin work or recording our Notice of Commencement.
Signature of owner/Agent/Lessee Signature of tractor/Lic nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFb m Mrd COUNTY OF &rt&a,�
The for R ing instrument was acknowledged before me The oing instrument was acknowledged before me
this -15 day of Ler .20 /5 b this for
t U 16 by
.26_
(rNL&Tn wledgin) (Name of person acknowledging)
ig ature N a6 Mbl-E- tat of Florida) (Signature of Notary Public- tate of Florida
P Known
0 Known 0 roduced Identification Personally Knwn Public-
Produced Identification
Typ f I erodu I ed - ___ i M '_ 111—
f Identification Produced 0��_
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BROOKE
q SQ1 My misSION 0 FF 240
Commission No. MY COMMISSION#FFggg 4,"m r ssion No. FE-244t655 Explms: une
My COM J 25 2019
EXPIRES,June 25.,Oil Thru Notary Publicunde-aer,
Bonded:
Bonded Thru Notary Pubro Un lewitars
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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