HomeMy WebLinkAboutBuilding Permit Application .-PPLICAKE INFO MUST BE COMPLETED FOR APPLICATIONTO,OE ACCEPTED
Date: Permit Number:
RECEIV'-:D NGV 12 2015
Building Permit Application
Planning and Development SLervices
Building and Code Regulation Division
2300 OrgWa Avenue,Fort-Pierce FL 34-98,j'
Phone,(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID 1. Lot No.
Site Plan Name, Block No.
Project Name:.
Setbacks Front Back: Right Side-, 'Left Side:
ke—
Wt work-to-In—pbrfibrmed un er thVs permit—chp-ek all that apply:
i7ld n a W I
—Mechanical Gas Tank Gas Piping Shutters Windows/Doors
Electric Plumbing T Sprinklers Generator Roof
Total Sq. Ft of Construction- Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
Name A144 Name: Ltrt(5 'S&Mrnotl_i
Address:, "f
/efe _c - Company: 'r sfe
City: 4State: rZ- Address: 15I S I( a Q rA-,n Dr -
-V d'Q
Zip Code- J�IfL Fax, City., Vovr 5-r LkciS___ d -j State: rt�
Phone No. Zipcoft �49_52) _3z� )-1b'y
Fax:
E-Mail,
Phone No._711 3�1:j:3Q'2_
Fill in fee simple Title Holder on next page(if different E-Mail: - C-Ute,Ir, S t V_ C'0 I-91 CV%
from the owner listed above) State or County License: CA C E5 La 1L? S4ate
It value of construction Is 240fl'or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
MCIRTGAG� tVIFANY. Not Applicable
Name: Name•
Address: _ Address: t
State: _ Elly: State;
1 4p: _ _Phone: zip: Phond:
PEE SIMPLE TITLE HOLDER: Not Applicable• 1Bt ribING COMPANY; _,.Not Applicable
me;, Name:
dress: Address;
Zip: Phone: �Ziip .Phone: -
OWNER/CONTRACTOR AFFiOVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commented prior to the issuance of a permit.
St.Lucie Cou makes no representation that is granting a permit will authorize the t:rmit holder to build the sub't:ct s9ructure
which is in conflict with an�t applicable Home Owners Associatiun rulM bylaws r an covenants that may restrict s pip ibit such
structure.Please consult au
your Nome Owners Association and review your deed?or 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 Buildipg 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 morns and accessory uses to another non-residential use
WARNING TO OWNER:Your failtire 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
P-o!nmencing work or recording our Notice of Commencement. f
..... ,
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE Of FLORIDA STATE OF FLORIDA
CiDUNTY OF . V C1 es COUNTY 01 :
The forgoing instrument was acknowledged before me The forgoing Instrument was acknowledged before me
this L) day of A/o xor s try tai$. aay of u .20_X by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Stitirof Florida) (Signature of Notary Public-State rids)
Personalty Known OR Produced identification Personally Known OR Produced identification
'type of identification Produta:Cl_ trxA&k£r—C 8 Be Type of Identification Produced
#IYcomm# t,'i�11�iI,
Commission No. � �� * I) EXPiREB:4014�8017 Commission No. "11'v��d 41 * li1`a i0liiii
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REVIEWS FRONT ZONiNG SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REViEW REVIEW
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COMPL.ET D
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