HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�� �$,�� Permit Number:
RECEIV"=D NOV 18 2015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 J
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential ✓
PERMIT APPLICATION FOR: G ��
Address: 7rsU�! oB ilyl 0A.1– M f," f 1 eYtc�= 62–
r ,
Legal Description: : /U1 62JLt?1F e�Mp0q rW ' L OT L( P9 �d'Z
Property Tax I#: ,+3 d3' ��� -OtSO ` Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
1t,S1al.l Ike 6- likse g1--k✓am.2 or
407
itiona work to be pe Orme un er this permit–check all that app y:
_Mechanical —Gas Tank Gas Piping Shutters ✓Windows/Doors
_Electric ,_,-Plumbing _ Sprinklers Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 1 7.s Y Utilities:. —Sewer _•Septic Building Height:
Name SW �CZL!-�,N 7Ad
me: ,6I'1a-�tX�l'`1a
Address: ?fv y t�l�iik OAT- ?52 mpany: !rliil Erns isexeu� PreCi r;or
Ad trar
City: rCYLCc State: - dress: t 1D8 7romahaok D/-
Zip Code: 3 qe?J f Fax: City: 1rVJi0A Aar1>V4, 6eav-h State: Ff
Phone No. 7?2 , 20 f , 06 y L Zip Code: 3Zgt37 Fax: 3Z1- 777- 1-1Z3cl
E-Mail: Phone No. 772-337-41LI70
Fill in fee simple Title Holder on next page{if different E-Mail: ( akv,5Sh aun a aho.:�• c..awn
from the Owner listed above) State or County License:
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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Er
Ina Normi "PE M
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 thepermit 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, 1 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 recQ)rding your Notice of Commencement.
Signatu a of Owner/,:Agent(Lessee Signature of.:Contra,ctor/License Holder
STATE OF FLO DA STATE OF FLORIDA
COUNTY OF.. COUNTY OF
The f0going instru ent wa5_a�cLknowledged before me The forgoing instru�rg}ent was acknowledged before me
this�day of � MWAG/ ,20� by this-T day of Ill DY20Z by
uncit
ame a person a n led ing} ame of perso nowledgi g)
g a urM Not u lic tate of Florida) ignat re Not u c-State of Florida}
Perso a y Known OR Produced Identification ersonall OR Produced Identification
pe o ica rQ uced T e of Identification P oduced
Comm cion NNo. „ti "y e BROoIC UGETI mmis ' 2� tom` Seal BR00
MY COMMISSION#FF244655 '{ MY COMM!ON#F# F244655
•b;? EXPIRES:June 25,2015 ` ' EXPIRES:June
. ..,F,. . , 4. 25.2019
Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MAN
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
-Re-v.712-014