HomeMy WebLinkAboutBuilding Permit Application 10/14/2015 09:40 FAX Q002/003
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l'
Date: A(�, Permit Number:
ar-
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: To Select from droPbox, click arrow at the end of line
I 1111101101:11!I11
Address: f i 3
Legal Descriptiop: ��.sis� 14 IleS zidr./ )6".'
Property Tax ID#: _OOD 2 — 00.0 S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Ct C CerS S �a`cPi� G�+ 5-/JL
rtiona wor1FoDeWpeormi"&a__u_nTe_r t is permit—c ec a app y:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ENlumbing OSprinklers FIGenerator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ e D� Utilities SewerSeptic Building Height:
Name //c.1 �f c 5 Name: o
Address._ 16.p_ �SL� :Company: t t f p1n �ti� "
City: fi .sf_ �ciie- State: Address: W YNI
Zip Code: �— Fax: City: QOc� S�'•1_LNn"e". Stater\• '
Phone No. �2' 3 ���� -.Zip Code: `�°��y Fax:2111 $_11—010bft
E-Mail: Phone No. $
11—0%11 CiIii
Fill in fee simple Title Holder on next page(if different `E-Mail. a►r t►^. �v►w. �71n^
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
10/14/2015 09:41 FAX 12003/003
DESIGNER/ENGINEER: -_ Not Applicable MORTGAGE COMPANY:
Name: !Name:
Not Applicable
—"
Address: Address:
City: State: ;City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: ^Not Applicable .'BONDING COMPANY: Not Applicable
Name: :Name:
Address: �ddress:
City: :City:
Zip: Phone: =Zip: Phone:
I certify that no work or installation has commenced prior to the issluance of a permit.
St.Lucie County makes no representation that is granting a permit ''it authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rt'I I s,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and riview 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 an' d'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 r8oms 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 intend to obtain financing,cons ith lender Or an rney before
cornu in -work.or reca - ' . our Notice of Commendetnent.
Signature of=RIDA
g 'Lessee '`.•, '�ignature of Conti tor/,{'.5ense.Holder
STATE OF STATE OF FLORIDA ll..
COUNTY OF COUNTY OF
The f Ding instrume t�w�as a-cknowledvPH hefore me The forgoing instrum nt w acknowledeed before me
this L day of �__, c20JS"by tris day of 4ZZI __.,gyp l,S Y
(Name of person acknowledging) (Name of person acknowledging)
{Sign of Notary Pu " - tate lorida} (Signat Not:��.pd&ftP0fZSLQAYA_
Personally Known den ification Personally Known
4:
Type of Identificatio Pr1L ¢ Type of Identification Produced`:
LIESLI _fit �I a
Commission No. '. MY COM ON#FF165172 `Y` EXPIRES ctpbar 1,2018
1 Commission No. ({ ea1}
?orad' XFIRE October 1,2018 :•t:t50 FlartdBNary3ervice.com
407 39"163 F1oridallotaryServ1cL,.com
Revised 07/15/2014
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