HomeMy WebLinkAboutBuilding Permit Application -.0PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -/-J- Permit Number; i 51 01060
ED NOV 10
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 t1irgirild Avenue,Fort Pierce FL 34982'
Phone:(772)462-1553 Fax, (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR.
Address: y Q IV 41A '/i%
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name,
Setbacks Front— Back: Right Side, Left Side:
OnPona WAork-to-b6peri'arms d under this permit-_cb_a_c-k-jIJ that_a_p_py_T_"'_
Zechani'cal —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: nd Utilities: —Sewer _Septic Building Height:
Name: eAir&S S1XW.Y_n0_t1
Address---- Sd Al ;(zf Company.* . Cqs_-r&m Vr &_g+ems kic,
City: Aeid& State:J-� Address- ti -
J5 �& T ' 1(6,0 Q F.Wk- Dr
Zip Code, ?41 9W'a Fax. city: P0 R,T- �T Ll.0 ie_ 'I 'J —State: rL
Phone No. Zip Code- 3_4 Fax:
E-Mail: PhoneNo.- , 77.2 33,5 -30.N_
Fill in fee simple Title Holder on next page if different E-Mail: - __ cust—sif, ig!lIq V �o I
from the Owner listed above) State or County License: C-ACOS1RIO - Sz '
If value of*onstrucUon Is 24OWor more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINE-ER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State:_ City: Stater
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 hermit willuthorize 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
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 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 recordlilig yourrecord" Notice of Commencement.
Signature of owner/Agent)lessee Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF We Ac c:, COUNTY OF 44e;,
The forgoing instru nt was.acknowledged before me The forgoing instrument was a knowledged before me
this day of —,2D by this r day of A���-tJ,20 z by
(Name of person acknowledging) (Name of person acknowledging)
1
Signature of Notary ubhc- to of Florida) (Signature of Notary Public. State of Lida}
Personally Known ,�OR Produced identification _ Personally Known t' . OR Produced identification
Type of Identification Produced Type of identification Produced.
' �°',;••:�fi CNHi87iPIEB.EI�(aI.I9Hz��
�I Py00MMISSIONfEE$592e Commission No.6-4-o,,-fa??� W..4
Commission No.���+.�� O � k al EXPIRES:April$,2017 '�`, EX���ONAg�
REVIEWS FRONT ZONING.. SUPERVISOR- Pl ANS VEGETATION SEA TURTLE MA GRRM;vt
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED -
DATE
COMPLETED
-Rev.77703.4
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