HomeMy WebLinkAboutBuilding Permit Application FEB-12-2016 FRI 12:32 PM CENTRAL SCHEDULING FAX No. 3212686138 P. 002
Date:. .- I ZJ _�� Permit Number:
RECEIVED FEB 121616
Building Permit Application
Planning and Development Services
Building and Code Regulation Division 1 P
23001rrginia Avenue,Fort Pierce FL 34982 �(
Phone:(772)452-1553 Fax:(772)452-1578 Commercial_ ._ Residential
PERMIT APPLICATION EOR: To Select from dropbox,.click arrow at the and of line �C--
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Address: 1 f i)
tl`7
Legal Description:
PropertyTax l[) �� y "' Sd 0 17 1-O a o, Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
1)19
NW)A
y� c•t Rp.
itIorna wor to e e orme un er is permit—c ec a appy:
�1VACGasTank Gas Piping _Shutters QWindows/Doors
11F_lectric El Plumbing OSprinkiers 1]Gene* rator Roof
Total Sq.Ft.of Construction: Sq.-Ft-of First Floor:
Cost of Construction:$_ UlJ• Utilities: Sewer Septic Building Height:
NMI
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Name Name.
Address: Company.
City: 1 State: Ad s
Zap Code. Fax: City_ \ 1 f State.
Phone Trp Code: Fax-_711
E-Mail: Phone No.
Fill In Fee simple Title Holder on next page{if different >-lvlail. a
from the Owner listed above) State or County L1cens _
if value of construction is$250D or more,a RECORDED Notice of Commencement is required.
FEB-12-2016 FRI 12;33 PM CENTRAL SCHEDULING i FAX�No. 3212686138 P, 003
�v�to I ��� '..�y 4 ` t v.,.• �� t r n
DE5IGNER(ENC�INEPR: �NotAppl[cabie MORTGAGECOMPANY: S9 Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip, Phone: 7 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 permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subjdct structure
which is In con ict 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 ahy•restrictions which may apply.
In consideration❑f 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 exemptfrom undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wails,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 pour paying twice for
improvements to your property.A Notice of Commencement must be recorded and pasted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement,
Sign re of caner/Agent/Lessee Signature of ontract cerise Halder
STATE OF FLORID — STATE OF FLORIDAQ
COUNTY OF . �e COUNTY OF
The f�going inst nt s aa�knowledgeid�b (fore me The f r oing Instru e t was-ac owledg before me
this day of _f—"�--, 20 HEY this day of 20 by
(Name of person acknowledging) {Name of person acknowledging)
ignature of Notary Public-State of 10" a j (Signature of Notary Public-State o ri a a
personally Known,jz_�,, OR Produced Identification_ Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission 4@112 ' al�athekipe Y�on$8 Commission a ,,'�$s hetlna CC0it 0JC
Coinmtssioa ll Np1728 _ , + Gammi:;s100 PF172372
28 7.01
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Revised 07/15/2014
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