HomeMy WebLinkAboutBuilding Permit Application ARAPPLIC6'SLE MFA MUST BE COMPL D FOR APPLICATION TO BE ACCEPTED
Date: ( (.0. Number..so���
RECEI''rD
JUL 0 12016
y Building Permit Application
Planning and Development Servites
Building and Code Regulation Division
2300 I lrginla Avenue,Fort Pierce FL 34982 f
Phone:(772)462-1553 Fax:(772)462-2578 Commercial Residential
PERMIT APPLICATION FOR: C_
k •4 n �t
66
Address:
411 155
Legal Description: 2 .�C cr I n C2e,s
Q
Property Tax ID#: = - 5:>2 Lot No.
Site Plan Name: Block No.
Project Name: 0� 0
Setbacks Front Back: Right Side: Left Side:
F.
xLY
A001TIOn8l WON To cie performep under this permit-c ec a a 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:$�'SUD.QQ- Utilities: —Sewer _Septic Building Height:
Name o Name:& Aic cold fflloneoa
Address: to tP AJ- Comp P0QA4JCQ0±ffAk
city: Address:-��5(Q.,o �, hal f State:j=L Address: 1a
ZipCode:ga:&�9 Fax: City'� �, a��-'� Stater
phone No. 6A)—_ m Zip Code: '54qSU Fax:
E-Mail: � Phone No.(-1"1
Fill in fee simple Title Holder on next page(if ci fferant E-Mail: GI iWS!V W,
from the Owner listed above) State or County License:
If value of construction-is 2540 or more,a RECORDED.Notice of Commencement is required.
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DESIGNS 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:
OWNER/CONTRACTOR AFFIDVIT.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,priorto the issuance of a permit,
St,Lucie County makes no represent tion 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 Homeowners Association and review your deed for any restrictions'whlch 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
commencing work or recorclingvdur Notice or Commencement.
Slgnature Owner/Agent/Lessee Signature.of Co or/License Holder RlhSTATE OF FLORIDA STATE OF FLORIDCOUNTYOP s�' 1, Ar_'� COUNTY OF `'�'
The fo_rlping.instrument was acknowledged before me The forgoing Instrument was acknowledged be 4
this day of 20_1�¢by this day of ZOj�,Q b a F a v C3
ro
CAI
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(Name of Pers cknowledging) (Name of per acknowledging) a 1 o m
Ca y-
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(Signature of-Notary Public-State of Florida) (Slgnaiure of Notary Public- tate of Florida j
Personally Known OR Produced Identification- Personally Known OR.Produced Identification
Type.of Identification--= - :=QIRUSSELL
Type of Identificatio
EBORAH �a� •���,
/ c`+° r n`r;4�6 Notar da sItill "Ls%,, OE QH'All RUSSELL
Commission No. >;$ lCommission No. Notary P� �ta""of Florida. My Camm.8xplr018MyComm.Expires Nov 30.2018
9 � Commission onoa 1 rough aCommission#.Ff--
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