HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Building Permit Application DEC 16 2015
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Luciernty,FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address: '.w
Legal Description:
Property Tax ID#: .= Q 0 t( M 15' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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ddAdditional workhto be performed under this permit—check all that appy:
,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:$ f Utilities: —Sewer _Septic Building Height:
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Name NW Name• Aet,4S
Address: _I W k S I Nflt w N-4rJ RComppny: Cr T 6- (e
City: G C;r�l E Rc State: Address: .AWL
Zip Code: ?a`A Qk%Z Fax: City: �� ����._ State:
Phone No. -1 a~- ao 1 L-1 Zip Code: 3 Fax: V61f n 4-7
E-Mail: dry _b�Cr�e r r Se IDhY). or!) Phone No Y 35
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License t�.S
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
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(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
operty Owner Name(Please Print)
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF
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ACKNOWLEDGED BEFORE ME THIS 1_ 3_„_.._DAY OF LJ 1—<-- �5.T .20_0_
BY 1 rNrl WHO IS PERSONALLY KNOWN TOME(_,'"A_)OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC TY-- PE OAR PRINT NOTARY
COMMISSION NUMBER
r (SEAL)
* t MY COMMISSION/FF 10 M
SLCPDSD Revised 04/11/2011 EXPIRES:J*18,2018
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