HomeMy WebLinkAboutBuilding Permit Application 12/15/2015 11:42 FAX 1a001/003
ALL APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / Permit Number:
RECEIV-D DEC 15 2015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: ilr jC,Q C-
Legal Description: t rt - -
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Property Tax ID#: 1415^ _ )C)E�5 - C�i60-- 1 Lot No. r 57
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormedunder this permit-check all that appy:
OHVAC 1_J Gas Tank ❑Gas Piping _Shutters F]Windows/Doors
L�Electric Plumbing Sprinklers 1-1 Generator F] Roof
Total Sq. Ft of Construction: S Ft.of First Floor:n
Cost of Construction:$ f � Utilities:0 Sewer U Septic Building Height:
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NameName: !� .•Lf?j u
Address: C- ti Company:
City: rD fl- Pl C. cc_' State: . Address: / 3/�"SGtI
Zip Code: G C Fax: City: Z�' S;l- Arc State: ��-
Phone No. —lee, Zip Code:2Z�2 6 "' � Fax: `77,2- 57/-
E-Mail: --��— Phone No. 7 - rcS-,7f
Fill in fee simple Title Holder on next page if different E-Mail: '• - � %� v �r_ 'Y�7
from the Owner listed above) State or Coun License: 6 its 6
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
12/15/2015 11:43 FAX X1002/003
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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:
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 1 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 sted on the jobsite
before the first inspectio . if you intend to obtain financing, consult with lender x orney before
comm cin work or r 'rdin our Notice of Commence en.
_Signature bf`Owndf/Lessee/Agent Signatur of Csonfract_rJ iCense Holder
STATE OF FLORIDA STATE OF FLORIDA -)
COUNTY OF COUNTY OF
The far oing instrume was acknowledged before me
/ The forgoing instrumegt was acknowledged before me
this day of 20/.�by this/r day of !r='= 20 Z-=, by
Zk�_ zll�lt//4–-
(Name of person acknowledging} (Name of person acknowledging}
(Signat Notary 15 ' tate of Florida} (Signature of Nota ublic-Sta Florida}
Personalty Known "" t3 prodiuF"lldw dt `lE,k341dA Personally Known =' l duce IiQa7.4U _AYA
Type of tdentificafiio �o' eri nay omMiSSiON#FF1&5172 Type of Identification Pr !C MY COMMISSION#FF165172
P= EXPIRES October 1,2018 'n ovr4'P: EXPIRES October 1,2018
Commission No. Commission No. 407 398.0159 FIO4&Ml�ryService:com
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS