HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONu
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Date:
INFO MUST BE COM'rLr i'ED FOR APPLICATION TO BE ACCEPTED '
Permit Num
Building Permit Applicatio
Planning and Development Services
Buildings and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
13
SEP 2 5 2015
Permitting d'...9ePartMent
St. Lucie e rlty® FL
Residential
PERMIT
APPLICATION FOR: To Select from dropbox, click arrow at the end of line
=PROPOSEDIIUIPROV°EMENT
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LOCATION.t i *�
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Site Plan Name: (a�)J� "t 16 � T'i Kni �, Block No.
ProjectName: (' a�)�ri e 1,:A Kn
Setback, Front_ Back: —+,s ' Right Side: Left Side: 10
C� ��n� � e ovl deck aV►cl
nC/P3 u,,f- �� 3
❑H AC IJ Gas Tank ❑Gas Piping
lectric Plumbing ❑Sprinklers
Total Sq. Ft of C"onstruction: POD Rgk'D`.Lt14�-
Cost of Construction: $ V ,C5-0 '2'3,,00 Utiliti
LJ Shutters
❑ Generator
❑ Windows/Doors
❑ Roof
Building Height:
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Name
Address
City:
Zip Cod
Phone No.
E-Mail:
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Name:
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City: I nc �- S+. Lv(i e, State: f
Zip Code: 3y qG a, Fax:
Phone No.
simple Title Holder on next page ( if different
Owner listed above)
E-Mail: 6�( i L ' c- C"
State or County License: -
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESI�NER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: -7r mry
Ar i
aS
Name:
Address: J
I 1 a 11
S God' P1aCQ- N (,f 41n
Address:
City: 9e6yvi &a0,
State: FL_
City:
State:
Zip:
Phone: 305-
9 9-9 -- OSAT—
Zip: Phone:
FEE SIMPLE
TITLEHOLDER:
)LNot Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip:
I Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucile 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
structu e. 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,
accessoII� 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 recording our Notice of Commencement.
Signature of Co
STATEIOF FLORI A STATE OF FLORIDA ,
COUN OF _ k, UVU COUNTYOF !k,L)C\�
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this
—AJkJ' day of /-, 1 20 I $ by this & day of AQ yr , 20 Lt_ by
(Name If pers n acknowledging) (Name of perso6 acknowledging)
(Signature of Notary Public- State of Florida)
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
d� •W Notary Public State of Florida
My Commission GG 201733
07/15/2014 iK..c4� Expires 03►29/2022
(Signature of Notary Public- State of Florida )
Personally Known X OR Produced Identification
Type of Identification Produced
Commission No.
Notary Public State of Florida
A Thomasina Bowins
Expires 03129/2022
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