HomeMy WebLinkAboutBuilding Permit Application P.2
Oct o8 15 o3:54p
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�b � Permit Number:
RECEIVED OCT 09*2015
Building PermitApplication
and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fart Pierce FL 34982
Phone:(772)462-1553 Fax:{772}462-1578 Commercial Residential X
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PERMIT APPLICATION FOR: To Select from dropbox. click arrow at the end of line -� V az'
•�1. 1' i T?... R 'l�Jt.'2.� 5yt•
Address: ( E0 4�7-1 qr
Legal Description: 1-r4,,k r i n -Is� ' )a LL'-" L&06-
- 6g C..'5L0 I --rZg - n .35 8 1399)
Property Tax 1D#: �.�(� ,! ! o
- O hs -coo~ (.t:, Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
.',x. i�a• - _ l G �. F ,. w .i•, �;` " - +i�.�' ' c^ z'r,a"4, 'r�}. sem, 1,n�:
ps i�n Lk -E.l l c `•��f 7t.p L 1�1 its 12 N w i`f-J'h a C.o f pe r- n it
f iza t+�t r2 G t L^ }c e r i E'S h' 1 v>r i c r�►-�
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�rtyrana viror toe e orme �un ert •is{permit-c ec a appy:
1"'IHVAG �Gas Tank Gas Piping _Shutters �Windowsf Daors
L`I Electric Plumbing �Sprink►ers Generator Roof
Total Sq. Ft of Construction: SQ.Ft.of First Floor:
Cost of Construction:$ _t5y D;R z Utilities: Sewer O Septic Building Height:
Name VO tka Y Name: -M)OLLJ)G� 4�'>astlZ y
Address Hui f-nOS Company: ... i Y" t`�l Dy--" tt�
State: -t Address: Cp '� SL� ) +15)i
Zip Code:x'062 Fax: City: °car - Calk?,_ State:V`,� l c,
Phone No. ` 7 7�- g!00 ra i Zip Code: .540'-'S Fax: "7-12 -
E-Mail: l Yn - 1--)-116A� 7�'X�. � Phone leo. �I"?a - g 71- 1 S LQ CD
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Fill in fee simple Title Holder on next page(if different E-Mail-
from the Owner listed above) State or County License: fi -
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
P.3
Oct 0815 03:54p
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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:
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 anti covenants that may restrict or prohibit such
structure.Please consult with your Horne 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}obsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
commencin r recordi ur Notice of Commencement
'-} '�-----` s
_Signature of Owner/Lessee/Agent Signature of onfractor/License Holder
STATE OF FLORIDA w STATE OF FLORI
COUNTY OF f: , L-i-t uIL-C-.- i COUNTY OF ,�' � , � -t..lC�,
The f rgaing instrument was acknowledged Wore me The forgoing instrument was acknowledged before me
this day of ?An __l•sj:f� , 20 _'}..by this day of � �c�1�1 ,20 t5 by
(Name of person acknowledging) (Name of person acknowledging)
A I/ �A
ns 4A�' "�- 'hJ
ig ature of Notary Public-State of Florida} ( ' at re of Notary Public-State of Florida)
Pe�rpei ailry Kn_q%vn--_><' OR Produced Identification Personally Known�_OR Produced ldentificatiot
Tp's.bfflffentific8tibn P aduced Type of Identification Produced ry
;" `.'' � .f;n4►�`, :s .. LINDA MARE BOUCHARD
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,ornmisslort J;o`-', . -. tE BOUCHARD ,� '
= MY COMMlSSIQN#FFi2552$ MY COMMISSION FFf25526
EXPIRES May 21.2018 v
OFR.,. F� '.
f r (407)39"153 FIOrlOaN01a SBN(CO,COtA (4071098-0153 Floddallolaryserviee.com
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