HomeMy WebLinkAboutBuilding Permit Application DEC-Ik2015 WED 09:30 AV CENTRAL SCHEDULING FAX No. 3212686138 P- 003
Datel LI W t \t) Permit Number: all"M
REC EIVED
Building Permit Application DEC IS 2215
Planning and Development Services PER!AITTIN43
Building and Code Regulation Division St- Lucie Ckul)ty, FL
2300 VirgInia Avenue,Fort Pierce FL 3402
Phone.,{772}462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox,,click arrow at the end of line
A 111 111:!1 11 W! ;1
AddressAz— "S�K"\
Legal Description: pgn� �(--zs
Property Tax ll)#: � Lot No,_n_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
25'6
pp Y'
r this perms c ec apply:
c a
iti n work to bep—ertormed un e
r1orl
C 71 Gas Tank Gas Piping Shutters Windows/Doors
Piping
CiElettric D Plumbing FISprinklers Generator Roof
Total Sq.Ft of Construction: 5Ft of First Floor:
Cost of Construction:$ 'Util it1e.51]Sewer[—]Septic Building Height:
'
31
Nam Ll'�" \ Name
Address:V—A C�Qn A��C'R— company:
C kL-X�s N e' : Address.
ity: Stat 14 rp t'�o C
ZlpCode:�LA,q-- t\ Fax: clty:%VvSok\"A��Ale—
Phone L �a Zip Code.` 4A- 1 .
E-Mail: Phone N
Fill In fee simple Title Holder on next page(if different E-Mai
ow)e 8 2�m'
.S-4
from the Owner listed above) State or County license:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DEC-1 -2016 WED 09:31 AM CENTRAL SCHEDULING FAX No. 3212686138 P. 004
_ ,,: ;� n,,. - � , ;• 'WPI ar,
RESIGNER 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.
5t.Lucle Caunmakes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which
[sin conflict with any applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Horne 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 rEcordinr,your Notice of Commencement.
Sign tur of Owner/Agen essee Signature of ontractorj icense Holder
STATE OF Of
COUNTY OF ORiD V `w._ C UNTY OF FLORIDA
-The orgoin gins ument wa ac�kknnowleciged b ore me Thefgrgoing Inst nt was acknowledged
wledgedd before me
this da of 2D b this day of 20 b
( ame of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of FI da) (Signature of Notary Public-State of Flon a
.Personally Known oR Produce dentification Personally Known 3�_OR Produced Identification
Type of Identification Produced Type of Identification Produced
gIttxlg
Commission N '�—_~ . otnmisslorOFF'172� Z'``1_� �Htte Kori a4
�}��. ommission N of I"172372
�� may, pc�He o �;apIms:=ze,aoae
.. )JJ q Mrpt n��y�Y /�
Revised 07/15/2014
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