HomeMy WebLinkAboutBuilding Permit Application ,?PLICABLE INFO MUST BE COMPLETED FOR APPLICATIOWTO BE ACCEPTED / d
Date: Permit Number:
Building' Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,fort Pierce>=t 34982
Phone: (772)4621553 Fax: (772)462-1578 .Commercial Residential
PERMIT APPLICATION FOR:
Address: Iqnrl �ri Q I u.Ia�
Legal Description:
Property Tax ID ,3�/a� D17 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
/Zai GIKe �'��•� /yS«� C�A�'s �vr' %o/t�/
Additional work o be performed under this permit—check all thatappy:
_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:$ - Utilities: —Sewer —Septic Building Height:
Name /A lgb :G190- �� r�� �-C)I-V7 Name: Lrtts Sa_mrnnori .5'
Address: gb&l 9 �c��!`�rck� �fU-'� Company: IAA<-r,,m A t"r
City: 4 Ur4_'5f State: FLS Address: i✓Q l5 S E `U r I Lug 4_�r
Zip Code: 2q2: 5�- Fax: City: yc ppj ST L4cle- State: FL
Phone No. x191 - Zip Cade: . 42_'�9_) Fax: U t�
E-Mail: Phone No.
i
Fill in fee simple Title Holder on next page (if different E-Mail: T s-V .n 1.s,rm
from the Owner listed above) State or County License: Cfl C 0 5 iR 10
if value of construction is2.sWor more,a RECORDED Notice of Commencement is required.
7,�_1PD
[DESIGNER ENGINEER- Not Applicable MORTGAGIt COMPANY: Not Applicable
ID FIGNERI
ES
Name: Name:
Address:
.4.4_".
ddress: 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 represent tion that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Assocition 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 recorglivg your Notice of Commencement.
Signature of Owner/AgenViessee Signature ofacto7rucemse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5P L-00, e, e ovoq 4t . COUNTY OF On e . 0
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1�day of 20 _day 2OL5
Jf� by this_L0_ by
L
(Name of person acknowledging) (Name of person acknowledging)
k�A'
(§gpatu-re ofNotarypublic--stAikof Florida) Signature of Notary Pubes ate of Florida)
Personally KnownV", OR Produced identification K. Personally Known OR Produced identificationn
Type of identification Produced Type of Identification Produced
Commission No. F_� DO"'15'7J (Seal) Commission No. rf 0.-:11575 (Seal)
T_
REVIEWS FRONT ZONING SUPER PLANS VEGETATION TSEA TURTLE MAN
COUNTER REVIEW REVIE' REVIEW REVIEW REVIEW RE\A W
DATE
—REcI IVIED
i
DATE
COMPLETED
--Rev.-7/2014