HomeMy WebLinkAboutBuilding Permit Application1_
ALL APPLICABLE INFO MUST BE f E APPLICATION TO BE ACCEPTED
Date:
Permit Number:
JUN 3 0 2015
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Planning and Development Services
Building -and Code Regulation Division
2300 Virginia Avenue, Fort Pierce -FL 34982
Phone: (772) 462-1553 Fax: (7-72) 462--1578
Commercial Residential
PERMIT APPLICATION FOR: To Select from.dropbox, click arrow at -the end of line
PROPOSED -IMPROVEMENT LOCATION:
Add ress:\t`�c`�`7
Legal Description \\, ass.
C`"�•c�� �ri �acc�cc.ec. k\c�mQs�s 3aV1�-k30`l
Property Tax ID#:y5\\- `�Da-�fJV$-Dpp-b Lot No.
Site Plan Name: Ntl�O\.A%,,. CSO� 'Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
'ONSTRUCTION.INFORMATION,
'
Additiop,al work to e e orme . under this permit - check
HVAC . Gas Tank E]Gas. Piping
Electric Plumbing OSprinklers
all tha apply:
_ Shutters.
E]Generator
L__L Windows/Doors
E]Roof
Total Sq. Ft of Construction:
Cost of Construction: $ ����
.S . Ft. of First Floor:
Utilities: Sewer E]Septic
Building Height:
;OWNER/LES'SEE
' CONTRACTOR: \y
Name: �e•Cl�� \a,�J�
Address:
Company: N,��z,
City:_'�s�. a State: _
Addr ss:s�
Zip-Code:3Nko(`g�' Fax:
City:
State-Ni.-
Phone No. -QkX%
Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple Title. Holder on next page ( if different
E-Mailw eSae\�,Y.�.�.C,r.cx���•"C
from the Owner listed above)
'State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
`SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 Corti mencementmay 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
corrurl'e-n-c-i% work or recording vour Notice: of.Commencement.
Signature of OwnEr/Lessee/Agent SigWre of Contrtactor/License Holder
STATE OF FUJAI'- STATE OF
COUNTY OFPAw COUNTY OFC��
The forgoing inst ment was acknowledged before me The forgoing instrument was acknowledged before me
thisp`� day of r'�,` 20 Eby thisa day of 20\& by
(Name of person acknowledging-) (Name of.person acknowledging) .
(Signature of Notary Public- State of Florida) (Signature of Notary Public -State of Florida) ,
Persona llyKnown ✓ nally Known fOR Produced Identification .
Type of Identificaiion'Produ d oll"le STELLA'M..K;ER Tyyp of Identification Produ e
Notary Public'. State o F rlda 1ELLA M. HUNTER
„
Commission No. :'jSeagommisslon # FF.180 5�q fission No. `o`""Y Pba�
e;= 'My Comm. Expires Jan 23 2019 . �•: Pudl� - StM� 01 Flog.:
Bonded through National Not Assn _ ' e Commisalon N FF 1 S055i
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Revised 07/15/2014
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