HomeMy WebLinkAboutBuilding Permit Application 11-25-'15 13:49 FROM- T-895 P001/002 F-907
ALL APPLICAISLE INFO MUST BE COMI OLETED' FOR APPLICATION TO BE ACCEPTED /
Date: aj_ / Permit Number._i G0 70q
a`I
Wilding Permit Application
Planning a4bge*oprnggt Servlces
Building and;Coit� D.iviSiBn
23W Viteink!Avert e,Fort Pierce RE349
Phone:(77,!)462;-1553 Fax:(772)4 2-2578 Commercial Residential
PERMIT APiPLICATION FOR:.
T 3 Select from dropbox, click arrow at the end of line —r> 0601,
Address` ✓
cl L a�K. v of �-
•
Legal DescriAtion:
i
Property Tax ID i1: o Lot Ne.
site Pian Nanpe: i Block Na.
Project Name: i 3333
Setbactts dont 2-5-6 Back: 7S`^ Right Sider Left Side:_325
I
ti •
vQN:STf li ,,t1t11±!1'yT N:*.
A00monal r to e+ a rmea urder t is permit-check a appy:
I
HVAC i Gas Tank ®Gas Piping _Shutters Windows/Doors
QElecirie Plumbing �Sprirtklers Generator F]Roof
Total Sq.Ft of Construction: Av A Sq.Ft.of First Fioo •
Cost of Construction:S utilities: Sewer Septic Building Height:
! i '
4tii1t :E C `:CONTRAC.0
Name
Address �! s O` Company:
City: UN } State•bL
Address:V4 'o Fj't�cue ct W 7
Zip ode: �i Fax---ZD -K City: hV'V44AWA1 Stater
Phone No. -063-7
Fax: 7R3p ,� 9,
E-Mail• Ph
�
_ one No.
Fill in fee simple Tjtip Holder on next page(if different E-Mail:.S 'A Q,QatoQr,�rtnn� �e.�
from the Owner listed above) State or County License:
If value of construction is$2500 or mor ,a RECORDED Notice of commencement is required. ;
I
11-25-'15 13:49 FROM- T-895 P002/002 F-907
.5k r.4'�Y•1�JV..t'. N•ti%•:1,.'�V .1 Au11 iNFOR'( A'f-,.l
�"r
DESIGNEIR NGINEER: Not Applicable MORTGAGE COMPANY: —Not Applicable
Name: Name:
Address:': Address:
City: '' State: City: State:
Zip: - Phone: Zip: Phone:
FEE SIMPL&ftiZHOLDER: Not-,-p% licable BONDING COMPANY: Not Applicable
Name: �...�.«..��.....��:•:M• :� .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 ape
,,trmit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Associon 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,1 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
commencin&work or recording our Notice of Commencement.
s
_Signature Owner/Lessee/Agent gignatur
ohtractor/license Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instru ent was knowledged before me The for ing instr ment wa acknowledged before me
thilr day of C 20 LS:by this lday of 20 JEby
0
(Na a of r acknowl Ing) (Name f per o acknowledg' )
)—a Y_ oifli
(Sign ture Notary•Public-State of Florida) (SignaIlly
re of ary ubbIQ-State of Florida)
Personally Known V OR Produced Identification Person Known ✓ OR Produced Identification
Type of Identification Produced Type of Identificatio Produced
Commission No. ,ge+",�':od�.(Seal1 C mission No. ,•"`y=d'��., (�jJ�yN L BREW=
.�4 KATHRYN L BREWTON `t'
MY COMMISSION 0 FF 47.'S ' = MY cOMMISSIOtd fF 4738
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS