HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1
ALL APPLICABLE INFJ MUJ BE SW PLETED FOR APPLICATION TO BE ACCEPTED
Date: J SCANNEU Permit Number:
BY 1RECEIVED
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r...` St. LUci rnnint. ���45®� Cf ��
Building Permit Application MAR - 3 2015
Planning and Development Services
Building and Code Regulation Division Public V: rks
2300Virginia Avenue, Fort Pierce FL34982 St. Lucie coin,.., FLPhone: (772) 462-1553 Fax: (772) 462-1578 Commercial _loo'00' Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
POSED IMPROVEMENT
Address:
Legal Description:
Property Tax lD #: I 0 3 - 5OZk - r,) D-7 - O p • 9 Lot No.
Site Plan Name: ^ L Block No.
Project Name: f kPie- Z* t, rce ;Rucc K_
Setbacks Front Back: Right Side: LeftSide:
DETAILED DESCRIPTION OF WORK:
II ONOJ 7bte - 35 _f&_t - hb h
CONSTRUCTION INFORMATION:
itiona wor to e e orme under tispermit-check all appy:
OHVAC Gas Tank ❑Gas Piping _ Shutters 0 Windows/Doors
[Electric 0 Plumbing Sprinklers 0 Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ & , 000 Utilities:[]Sewer 0 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Ge
Name:
Address:
Company: �Elig Wig- VS
City: a State"Q
Zip Code: wSL14 Fax:
Phone No.
Address: �J"7� C
Clty:l tZe 42 Sate:
Zip Code:7J3 Ll 0-1 Fax: //t- LDS'
PhoneNq. 'Jlp)- roaar 551S
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: JIM OfAw N A Q%1AW 1L43k:
- P1,9
State or County icense: C
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
t " '
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: III
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
re the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
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 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
I'SignatuKe of Ocaner/ Lessee/Agent
STATE OF FLORIDA—
COUNTY OF r4 �71/ilf` h
The this= goin instru ent_rr_ washknowle201before me
this a of rnavn 20 r..7"
f%& latintr+
(Name of p n acknowledging)
(Sign[A- Ps ig#ktary Public- State of Florida )
Personally Know a�.lreeci
Type of ]dentific i " "' UGW P. KEMPTON
Commission
Commission No. ExpresNovem016
retire 57019
Revised 07/15/2014
STATE OF FLORID }�
COUNTY OF V44 &A it I
The forgoing instru ent was acknowledged before me
this �dayof 1Q�Gh .20 J:Sby
�4ier 4- ZAwe
(Name of p n n acknowledging)
rLP.",
(Signs otary Public -Mateo rida )
Personally Known f✓/OR Produced Identification
Type of Identification Produced
Commission No. ! _%k JONI P.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
? �/
COMPLETE
5I6
INITIALS