HomeMy WebLinkAboutBuilding Permit Application .PPUOWLE 11*0 MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date, Permit Number:_ 0-
RECEIVED
Building Permit Application OCT 21 2015
Planning an*d Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34991
Phone:(772)462-1553 Fax: (772)46241578 Commercial Residential
PERMIT APPLICATION FOR:
Address-
J e.,
Legal Description:
Property Tax ID#-. Lot No.
Site Plan Name: Block No.
Project Name.
Setbacks Front Back: Right Side: Left Side:
�ti a worK to be pertormed under this permit—check all that apply:
Mechanical GasTank Gas Piping _,Shutters Windows/Doors
Electric Plumbing Sprinklers —Generator Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ rQ, Utilities: —Sewer _Septic Building Height:
Name NamZ-/� Name: S.A.M M-,2 ti
7Ad dress: Aff-Ifl ".4 a('r. c )AI-C,
Company:
City: A/2Azd& State- Address: 1 15 r"e k Dr-
Zip Code: 60—#40 Fax: city:
Q ea -�T LJ state.-rL.
Phone No. Zip Code: 3-425x) Fax- 190
E-Mail: Phone No. 7,72 -
Fill in fee simple Title Holder on next page if different E-Mail: c-u-sTA it
from the owner listed above) State or County License. CA C 0 6 J R 10
if value of construction is, =ror more,a RECORDED Notice of Commericement is required.
F7TIP:
ENGINEER: Not Applicable MORTGAGE COMPANY: � Not Applicable
Name* Name:
Address:
State: City: _ State: ..
Phone: dip: Rhone'
TiTLE HOLDER: Not Applicable BONDING COMPANY: l,Not Applicable
Name:
Address: Address:
ccrry: — ---- City: —
Zip: Phone: Zip:I 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 Counttyy 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 Horne 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 rooms and accessory uses to another non-residential use
WARNING TO OWNER.,Your failure to Record i 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 recur ' R your Notice of Commencement.
Signature of Owner/Agent/ essee Signature of Contractor License Holder "
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of .� "d. ,20/3" by this _day of r-z-d ., ,24 5•by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary
PubliSt of Florida) (Signh'ture of Notary Public tate o tirida)
Personally Known Produced identification Personally Known OR Produced Identification
Type of identification Produced Type of Identification Produced' ,�.
::•'•: PIES.EN13U H �"G-"�"'t5 r �ti'� � ''•`'�`2 GHRIMNE B.�Li$H
Commission No. * l MYCOkMSSIMEE agommission No. w "yCO&INSION#EE 859284
EXPIRES:Ap'til 4,201 r EXPIRE$:Aprt14,2017
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REVIEWS FRONT ZONING• ' SUPERVISOR- PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW' REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014