HomeMy WebLinkAboutBuilding Permit Application P.1
Oct 2015 09:04a
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: �' c� � 1� Permit Number
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SII jRECEIVED
Building Permit Application OCTa-0 2015
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue.Fort Pierce FL 34982 y.'r
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lime
Address: �. 1`lG�"-Tl� }�lf� � �C}tP �f�' �if'.YCt� �..• ��'t �;,
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Property Tax ID#:_ _�'t (Poo 0 `A a -- C)tO— (0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional wor to OenGas
eorme un er t is permit-c ec a app y:
@HHVAC Tank Gas Piping _Shatters �Windows/Doors
Electric Plumbing []Sprinklers Generator Roof
Total Sq. Ft of Construction: SQ. Ft.of First Floor.
Cost of Construction:$_q'Li 2.00 Utilities: (`
Sewer 1�,J Septic Building Height.
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Name X1...iW4+ Q 0- Gr7bL� oat Name: tiL�� } •
Address: '32.DO IR146LO J&,1,4 Ffin-C-(A Company: f r t`�'lt3
City: �byt pleyr " State: 4 t: - Address:_GQ S `)a �A-VnDf-e f21
Zip Code: � 'I� ( Fax: City: Z.t t{?.t _ Stater.
PhoneNo. '� (o c��l �� zip Code � ',��` Fax: -ITA-'04-35111
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E-Mail: Phone No. —t7 0�-~ 1 --kGG O
Fill in fee simple Title Holder on next page if different E-Mail: /� ' e'r'ikU
from the Owner listed above) State or Co my License:
If value of construction is$2500 or more,a RECORDED(Notice of Commencement is required.
Oct 2015 09:04a p•2
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DESIGNERANGINEER: —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:
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 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,l 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 roams 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
commencin r records ur Notice of Commencement
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Signature of Owner/Lessee/Agent Signature of ontractor/License Holder
STATE OF FLORIDA _ STATE OF FLORIM
COUNTY OF lett rl'��2 ' }.L e. COUNTY OF ft_ 7:5-. UQCS-12 -
The forgoing instrunt was acknowledged fore me The forgoing instrument was acknowledged IIme
this-1`I,o day of t 20 Eby thisday of� •G 10.x'1 ,20 1--_Dby
(Name of person acknowledging) (Name of person acknowledging)
En __OIQ44
(Si V-turd-of•NotPublic State of Florida) { gnature of Notary Public-State of Florida} '
ary
?e.*satia3ly i�rio,rr _ ?�OR Produced Identification Personally Known_ OR Produced Identificatian ,
y e of Identification koduced Type of Identification Produced =
_ ~. =~• jNr:.. �. ;.a-•li'�-. Comm, ��,..,.�v,, LINDA MARIE BOUCHA
CAmms"ssEan }a? ytpippMAR11JGFIAHD m sit al}
I MY COMM{5SiOnI#FF125528
MYCOPAMISSION#'FF125526
EXPIRES May 21.2018
as tom,+ ay 1,2018
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