HomeMy WebLinkAboutBuilding Permit Application ,j)PLICMLf.INFO MUST BE COMPLETED FOR APPLICAMONTO BE ACCEPTED
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Date: Permit Number: �'
Building Permit Application
Planning and Development Services
-Building end Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 3498,2'
Phone:(772)462-1553 Fax:(772)462-:L578 commercial Residential
PERMIT APPLICATION FOR:
Address, '' dalduA� O&W
Legal Description:_
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name;
Setbacks Front ,_ Back- Right Side: Left Side:
1w.ce&r CIA Y1.5 C� �w V,
407tim"aworktobape ftrmecl uncler tnis permit--check all tat apply:
—Mechanical Gas Tank —Gas Piping Shutters Windows/Doors
—Electric Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction- Utilities: —Sewer _Septic Building Height:
,F
Name d
Name: CLtrttr3 '50Aymorl .�
Addre(s; AW company: L! -nom- At'r 5,,iSfeM� )A-J-C,
City- 60A�z�- 4zz-e'-; State: L Address: t W 5 Dr -
Zip Code- Fax: city: poe--� ST C I_e_ State*.E-
Phone No. Zip Code: .34i&l - Far. 335" )-UA—
E-mail: Phone No, 7-7g 33,5 -3;jl
Fill in fee simple Title Holder on next page(if different E-Mail: Cus aLif, St4v 0 c o 1, ,C'A
from the Owner listed above) State or County License: CACOSIRIQ SiAL
If value of construction is2hKor more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: ""ble MORTGAGE COMPANY: Not Applicable
Name' Name: _
Address: Address:
City; State: City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: 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 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,I do hereby agree that I will,in all respects,perform the work
irl 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 recordog yourrecord' Notice of Commencement,
signature of owner/Agent/ essee Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF /-�
Theforgoing instru entvy?s acknowledged before me The forgoing instrument was acknowledged before me
this t! day of .mac. ___120/1f by this_�L_day of 42as;; LAe ..__-_ ._,20_W by
t &X27-UL
(Name of person acknowledging) {Name of person acknowledging)
(Signature of Nota7Pub ic-State (pride I (SignXture of Notary P Sta f Floirida)
Personally Known OR Produced Identification Personally Known . . _ OR Produced Identification
e y .
Type of Identification Produced Type of Identification Produced.
L �,,w�:`.:uec� CIiRISiINE E� ,s �• � CWRI 7M B.MGW3
Commission No. *MYCAMMlstl%kEE 6i�rnmission No. ., # MY COMMISSION IIEE859
EXPIRES,ApOl a, 017 EXPIRES:Apr9 d,2017
P'"W To w Kai�ip r kR§ X44 eo-�` Omdld Thor Audge W Sera(
REVIEWS FRONT ZONING, SUPERVISOR, PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW. REVIEW REVIEW REVIEW . REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
712014