HomeMy WebLinkAboutBuilding Permit Application ..PPLIC,ABLE INFO MUST BE COMPLETED FOR APPLICA,TIONTO BE 1IXCEPTED
Date• //-6?S �/5' Permit
Number•
RECEIVSD NGV a5 25b
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce F4$4982
Phone: (772)462-1553 Fax: (772)452-1578 Commercial Residential l�
PERMIT APPLICATION FOR: J
Address: ' 02
Legal Description:
Property Tax ID##: a� 7L3/� ,� /- G��^/ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back: Right Side: Left Side:
L Il'� 0�''r Gll�c_. ,�'� �415� G'��nsc.� ��/�,r.✓ .
Addi
Mona work o e pe rme under this perrhit-chpck all that appy:
/Mechanical Mechanical _Gas Tank Gas Piping Shutters Windows/Doors
_ Electric Plumbing Sprinklers _Generator _Roof
Total Sq. Ft of Construction: _ _ .. _ Sq. Ft-of First Floor:
Cost of Construction:$ $'6 _ Utilities: —Sewer —Septic Building Height:
Name— a r t �� Name: Lurtts ,Sawn roil
Address: /w/ uI`u_ 4 Company:_Cus.�rem 8 '(- &u ,femn )iyc_.
City: Via[N/,g-,r /t9 ' State: Address: t4 15 S Ti' I . G(rat n Dr -
Zip Code.• O VV,?,� Fax: Ci c1
State:
ty: r�+tZT__�T L.].rC��, FL
Phone No. e77-,91J y Zip Code:3-4 9 Fax: qu_._j3S l 1 g
Phone No. 7
._
E-Mail: -� _
_.._ . 7� 3�,5 3el 3'1
Fill in fee simple Title Molder on next page(if different E-Mail: - C4sU1r SLl-`°aao I.c r,,
from that Owner listed above) State or County License: C fl 005 I's?10 -,S'nle.
If value of construction Is2MThr mare,a RECORDED Notice of Commencement is required.
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e
DESIGNER/ENGINEER: Not AppliTble MORTGAGE COMPANY: Not Applicable
Name, Name:
Address: Address: Statex
City: State:_ City:
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 an j 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,per-form 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 pro Pe 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 recur * our Notice of Commencement.
Signature of Owner/AgSignature of Contractor License Holder
Agent/ re
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this f day of 2OZr— bythis -2,
day of
J- 204f by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-6fate of Florida) (Signature of Notary Vublic-Se of Florida
Personally Known. OR Produced Identification Personally Known OR Produced identification
Type of Identification Produced- Type of identification Produced
V OMMISSIONIIEE020 3y COMMISSION 0 EE 859204
n No..-
Commission No. &Y417144��**%IM) E�Xf IRES:APO)4,2017 Commission EXPIRES:April 4,2017
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW RMEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
KeV.772014