HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
R E C*3'E I V E D
Building Permit Application DEC 2 3 2015
Planning and Development Services
Building and Code Regulation Division PER.41ITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Luciety, FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of linemec6nitg
Address: �-V' I
Legal Description:
Property Tax lD#: Lot No.
Site Plan Name: De.41 U6-1 5a'k2�m Block No.
Project Name:
Setbacks Front Back:. Right Side: Left Side:
NC C�YW, OUt i *e_
mniqnal work to e"joe ormed under this permit—cheCK all MAI apply:
HVAC U Gas Tank F]Gas Piping Shutters Windows/Doors
FlElectric FlPlumbing OSprinklers Generator Roof
Total Sq.Ft of Construction: SFt'of First Floor:
Cost of Construction: Utilitiesll Sewer Septic Building Height:
Name Q'V")P'V k k ri Name:
Address: Company: Ggl
City: State: Address: 582 NX M,,r,, 'Nlf
Zip Code: Fax' �h 4N, City: ,,, State:
Phone No. Zip Code: Fax
E-Mail: Phone N(
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:i2bel-3—Iq
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
12/22/15 11 OlAM Adgm'�. A].t Condi tianinq, Inc. '1'32-878-3951 p.02
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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 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 o 1 end to o in financing,consult with lender or an attorney before
commencing work ar r ' In r ati ammencement.
S of ner A n - Si at to .C' ntractor/Lic a older
,8TA�E OF FLORIDA ATE OF FLORIDA
COUNTY OF t , � t t Li 63_ COUNTY OF "!5j .A,�
The fo instr gent was acknowledged before me The fo ing instru nt was acknowledged before me
this Ty�bQ r 20 l�by this ay of �ObY
O'k eylL IL-A V-1
1��L 1�1�;�.
(Name of perso acknowledging) (Name of person acknowledging)
44/a A 0 JA 0 a. Q Z)All d A /-A L'" aCCJ-_Xb-t'X o t-�'
Signature of Notary Public-State–of Florida) (Signature of Notary Public-State of Florida}
Personally Known t OR Prod ed identification ✓,/ Personally Known OR Produced Identification
Type of Identification Produced L)L' _ _ Type of Identification Produced
Karen Roessner
Commission No. NOTAi> BLIC Commission No. Y PUBLIC
STATE OF FLORIDA —11NSTATE OF FLORIDA
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WE)Ores 6/16/2018 Expires6116M18
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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