HomeMy WebLinkAboutBuilding Permit Application r=
a'PLICABLE INFO MUST BE COMPLETED FOR APPLICATIOIWTO BE ACCEPTED
Date: /0-/d/-r Permit Number:_ 151 G Q�
Building Permit,Application
Planning and Development SL-rvices
9uilding and Code Regulotfon 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 ID#: /,�6 ��d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front. Back: Right Side: Left Side:
Additional work to be performed under tis permit-c gc all that appy:
'Mechanical Gas Tank T Gas Piping Shutters _^Windows/Doors
.Electric Plumbing _Sprinklers —Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 3.s'75— Utilities: —Sewer _Septic Building Height:
Name Name: L.urtl5 S
Address: Company: CA!;--a-m A t'r- 5!4 s few_,. l�C,
City: __iu;/�,r ,c e� State: Address; I�I S S;.,
`U i r
Zip Code:_ _ Fax: City: _
�Qe.�c T Lkct� State:
Phone No. Zip Code: 1} Fax: '77;..33'5-J fro R
E-Mail: _ Phone.No. 7 `2-
Fill
zFill In fee simple Title Halder an next page (if different E-Mail: c stair su v o.1-ec
from the Owner listed alcove) State or County License: CA C 05 !,210
if value of construction is 25Wor more,a RECORDED Notice of Commencement is required.
7'Po
DESIGNER/ENGINEER: w Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: - -
t;.; y: State: City:_ State:
Zip; Phone: Zip; Phone:
FEE SIMPLE TITLE HOLDER: ,Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: - Address: —
Crty: __ 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 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 recordinig vourrecord' Notice of Commencement.
Signature of Owner/Agent/lessee Signature of Contractor License Holder
STATE OF FLORIDA fiiSTATE OF FLORIDA
`� COUNTYOF S7-
COUNTY OF -
The forgoing instrument was acknowledged before me The forgoing Instrument was acknowledged before me
this /o2,day of _. 0-&ZB'�::S 2. .20/.S by this_Ld, day ofc7c�d'be r ,20_15 by
aeffill
(Name of person acknowledging) (Name of person acknowledging)
(signature of Notary Public-State o orida} (SignSture of Notary Public-Stat Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of identification Produced Yh Type of Identification Produced
rM ZARY Pb
y fYCOMMISSION�EEEt UM 4: .& qyp
�� ) EXPIRES;ApH14,2017 Commission Na. - �, �4FCpMMtS9fOKaE g3828a
Commission No. 4. e g
n''FOF VL BoMad TAru BvdgetNMary S , ?, EXPIRES:A rri
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REVIEWS FRONT ZONING. ' SUPERVISOR- PIANS VEGETATION SEATI.JRTL I* IMANGROVE
COUNTER REVIEW REVIEW' REVIEW REVIEW REVIEW REVIEW
DATE
RECElVEO
DATE
COMPLETED
Rev.