HomeMy WebLinkAboutBuilding Permit Application e4 Xa 6 fit"
,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
10,ly L tis Permit Number: –Q o
RECEIV"=D OCT 14.1013
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial _ Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax I b#: �- c7- ... ---- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: - Left Side: _
Gl/�cc GIDS= 'I or. /Seer at%-^SC- 0;1V
Additional work to be performed under tis perms –check all tat 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 .�/� ._� 2 Pilo � �yup� Name: (Urtts so-m non 6
Address: Zdj7 A :�,,-, Company: Air S
City: �Pi2 t o _ State: >C2- Address: (gyp 15 S1< 9Jr 1 r
Zip Code: Fax: City: T State: L.
Phone No. r7 " %�'�/SSS Zip Code: 4 9S Fax: ` ,72
E-Mail: _ _ Phone No. 77 "31z3 l
Fill in fee simple Title Holder on next page(if different E-Mail: Cl sfcglr- Su! q-, CGo 1•(.t+-
from the owner listed above) State or County License: CA C 0 5 1,1?!O SW'2._'____
tf value of construction is258dar more,a RECORDED Notice of Commencement is required.
R,
DESIGNERIENG1NEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City; - -... _ _ _.... .. - City:--- — ----
Zip: Phone: --...- ... — - ... ._. — Zip= -- --Phone:
OWNER/CONTRACTOR,AFFIDWIN,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 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
commencing work or recorftg yourrecur ' Notice of Commencement.
'Signature of Owner/Agent/lessee Signature of Contractor License Holder
STAVE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_,�k day of__.._._ ,Gi - ,20„5 by this_4L_ .r day of 20_Zyby
Mar r+' XymIna nsS-
(Name of person acknowledging) (Name of person acknowledging)
Ts-ii-nature of Notary P/ 1c-St of Florida) (SignSture of Notary Public- tate Ida)
Personally Known V/ OR Produced Identification Personally Known_OR Produced Identification
Type of Identification Produced .. Type of Identification produced
� :-•,, 04 goo HIM 0.�
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Commission No.�u�ds�vl� * I�COMMISSION 4EEB592114 ������ �`,. a .�pIST1►IIEg,FAIq�H
a XPIRES;April 4,�2017 Commission No. k * }COt1MIS910NOEEM284
ef4�DrF,9* D.mtkdnffU8dDMlNohp8awlgo EXPIRES:hpr84,2p17
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