HomeMy WebLinkAboutBuilding Permit Application ALLAPPLICABLE INFO MUST BE COMPLETED FOR J 3PLICATION TO Z ACCEPTED
Date:__/v Permit Number: 0 �0
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RECEIVED
Building Pr rrnit Application OCT 2 8 2015
Aldrining and Oevelopment Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 1
Phone:(772)462-1553 Fax:(772)462-1578 -o� rrlerciai Residential
PERMIT APPLICATION FOR: ToSelect firc n &opbox, click arrow at the end of line
PROPOSED IMPROVEM'EN:T-.L.-,6C--A,-TION.-
Address;
a4 SGWo_nija 0_tcb
Legal Description-
PropertyTaxll)#: 34 2,25--72(e Lot No. 0-9
Site Plan Name: — Block No.
Project Name: L-'y-0-0Un-e_ thckl?
Setbacks Front Back: Rio it Side: Left Side-
P,eNda_
t4 GEDO- 3is C KUD
.CONSTRUCTION lNFOkMATI&N.".:
AcId Itio na I worZT60T j_ fform&cF_un er lhmperm _cneCK 211 Mat apply:
W—HVAC Gas Tank F]Gas P ging Shutters F]Windows/Doors
Electric Plumbing OSprir. lers Generator CRoof
Total Sq. Ft of Construction: Sq. Ft.of First Floor;
ISewerFleptic Building Height:
Cost of Construction:$ Utilities:
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OWN`tk/L�&: C
Name LcV_(_6LFn_e_ _ Clt-C;_ Name, Ue4PrP_"( V.
Address:E
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City: State Address:
Zip.Cade.-
_�_7(ci Fax: 5'IS--!3-7 Z '7 city: 'k State
PhoneNo- -2_>4e-c3-7`Z-5 Zip Code: Fax: S--FS_9�-Z__7
E-Mail- eh�: �5Wtl 111-10.0 Pi)e-Y11WC1S[.- TfT- Phone No-
fill in fee simple Title Holder on next page(if diffc- -ent E-Mail: a. r r i C
from the Owner listed above) State or County License: CjqC._b6(;'A) _2_eo
If value of construction is$2500 or more,a RECORDED erica of Commencement is required.
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DESIGNERIENGINEER: —Not Applicai :e MORTGAGE COMPANY: Not Applicable
Name: Name.
Address: Address:
City: State City: State:
Zip' Phone' Zip: Phone:
E EEE SIMPLE TITLE HOLDER: Not Applica le BLINDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: phone:
I certify that no work or-installation has commenced pri r to the issuance of a permit.
St.Lucie County snakes no representation that is grantin a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners As )dation rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Assoc tion and review your deed for any restrictions which may apply.
In consideration of the granting of this requested perms I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Builc ig Codes and St.Lucie County Amendments.
The following building permit applications are exempt f► m undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,sigi .,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a :o4e of Commencement may result in your paying twice for
improvements to your property.A Notice of Cc nrriencement must be recorded and posted on the jobsite
before the first inspection.IfWu intend to obt in financing,consult with lender or an attorney before
commencing k or reca our Notice of :ommencement. All
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Signa ner! .ssee/agent �"ic 'i , -� Signatu# �o radoc/tic t►seliotder �c%rrr�a�
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this.7�day of tk+-y ro_P_, 20 15 by thiSIX' day of Q 20 t c- by(Name of person acknowledging) (Nal m of person acknowledging)
(Signature of Nb r�&blic-State of Florida) (Signature of Neta' Public-State of Florida)
Personally Known ✓ OR Produced Identification Personally Known z "� OR Produced Identification i
Type of Identification Produced Type of Identification Produced
Commission No. ie FC�f� � f;' i �" (Seal)
....,T�� (Seal) Commission No./�t�C�1��� Seal
Gail H. GE Ale ; ;Y.," Gail H. GeMle
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