HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEI o Nov 18 2015
Building Permit Application
Planning and Development Services
Building and Code Rf eaulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-,11553 Fax:(772)462-1578 Commercial ' Residential ✓
PERMIT APPLICATION.FOR:
C
Address: G 5A/A
Legal Description: eoz� LAII &- &I-co
e dK t(6-(- -2/17)-
Property Tax lD#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
lasia(l I i ke Cot- like cwvanz &or
Iditionamno"r to be performMemalmumn"er this permit-check all that apply:
—Mechanical Gas Tank Gas Piping Shutters ZWindows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
,2
Cost of Construction:$ Utilities: —Sewer Septic Building Height:
Name Joax, era-er Name:_ 6rmn na
Address: 9-n?p Mcmr-Ar->1r. Company: Mill ErAerorise oC &-eudJb-a D
IM/
City: Fbir4-Ptfrmn state:FL_ Address: i105 o,,"aliaf3k Tv
Zip Code: 51444CI Fax: N1 P, City: Indian Aarbmv Geacv� State: Ft
Phone No.(11'1) '_"J5'A-0Xke1D Zip Code: 3293_7 _ Fax:_32,1- 777- W3
E-Mail: ti Phone No. 772-337-111170
4A- '
Fill in fee simple Title Holder on next page if different E-Mail:_(.qke5shaynnkP. V* AkW - C_C)r-1
from the Owner listed above) State or County License:
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable 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
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 recording our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of.Contractor/License Holder
STATE OF FL RIDA �,,� STATE OF FLORIDA
COUNTY OF j��� COUNTY OF
The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this�day of MJ]r[., 2015 by thisILP day of "bVeN1bCk7,206 by
S
{ ame per
ledging) { a of person ackn wled }
ign re of No r lic-State of Florida} { ignattie Pu Iic-S to o Florida)
Pers ally OR Produced Identification Per nally Known Prod ced Identification
Type of tific ' Produced pe f Identihcatio Prod ced
SZIG
Commission No.`LjC
= ��ealj{1,�COMMIS ON COMMISSION C m ion =+ rl e �}COMMIOOXE�S�
44655
EXPIRES:June 25,2019 8JUn N 5,2019
EXPIRES:Jtme 25,2019
Bonded Thru Notary PubBe UndenArritcrs °,!; �, Bonded Th.Abla
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW .
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014