HomeMy WebLinkAboutBuilding Permit Application All,APPLICABLE INFO MUST BE CGIYIPLMD F®�APPLICATION TO BE ACCEPTED i
Date: 013E' Permit Number•
RECEI7D JUN 2 0 2116
Building Permit Application
Planning and Development Services
Building and Code Regulation Divislon
2300 Virginia Avenue Fort Pierce FL 34882
Phone:(772)462-1553 Fax:(772)462-1575 Commercial Residential
PERMIT APPLICATION FOR:
MM 0 12
Address, + � - I
Legal Description: ��n►`
r►A ,cal. e A �L��r-f i r t l"�yl4 '"�f L l (� ( �"�� �� EL Zi q�?r
Property.Tax ID#:I ` DO d cco - Lot No. ,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _- Right Side: Left Side:
J. W
OEM
7 fl iJ 14e
10
Additional wo, o �� performed under this permit-c e a a app y:
,Mechanical a Gas Tang: ®Gas Piping Shutters �,Windows/Doors
_Electric ,-,_Plumbing Sprinklers _Generator �,- hoof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ C11 c.00 Utilities, —Sewer _Septic Building Height:
Name M 'lda Name: Gly* 1
Address: I&R04I Company: RP7
City: t CLvt'?{ State: Address: f2 l * Pl
Zip Code:331`r?L o _ Fax: city:--PS. f✓ Stater
Phone No. '-7:22- Q5-- q(g�4 0 Zip Code: ]2±z.Q(-9 Fax:
E-Mail: Phone NC-1-lob
Fill in fee simple Title Holder on next page(if different E-Mail: � r • Cp
from the Owner listed above) State or County License: l 3q
fit
If value of construcition•h 2500 or more,a RECORDED Notice of Commencement is required.
2/Ed Wd2T:ZT 9TOE 02 'unf Z0b9672ZZZ: 'ON Xtid sa3lAuaS SNG: WM:l
P
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: T 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:
OWNER/CONTRACTOR AFFFDVIT:Application Is hereby made to obtain a permit to do the work and installation as Indicated.
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 ermit holder to build the subject sgruqure
which is in conflict with any applicable Horne owners Assonation rules,bylaws or an�wvenanu that may restrict or pro iblt such
structure.Please consult with your Home Owners Association and review your deed r 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
corn imencina work or recording o r Notice of Commencement.
Signature Owner/Agent/Lessee Signature of Co or/License Holder
UNOF
RD UOF
STATE
OF + STATE
F°_ 5;�—, LL.LC�.t �.
The forgoing Instrument was acknowledged before me The forgping instrument was acknowledged before me
khi anay of 26Uby thi T^day of 2 i U by
(N me of per cknowiedging) (fie of pe acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Publi tate of Florida)
Personally Known OR Produced identification Personally Known Oil Produced Identification
Type of Identification Produced Type of identification Produced
°°�°,,,, DEBO�ti� SSELL Commission NO. • y" o`'•. DEBORAH RUSSELL
Commission No. °' °" ''•% Ory Publi��9tte o1 Florida 15��
r , �?—Tfo���y PuDltc State of FI
'r* " fres Nov 30,2019 •; ; My Camm.Expires Nov 30, ,
ie My Camm-Exp
• = ,,
q Nation I Natar Assn.'s ?'•.
,+�. ..,r '%°I�'��` nde i � ars • '
REVIEWS PRP7�U ° SOR PLANS VEGETATION `,SE11ltTJ�°.�.. �t �•
-REVIEW REVIEW REVIEW REVIEW REVIEW 11015W
DATE I
I
RECEIVED
DATE
COMPLETED
2/Rd WdbS:ET 9TOE 02 •Unr E0b9VV2E Z: 'ON Xdd saotnaaS SNQ: World