HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFP MUST BE COMPLETi•_ -,OR APPLICATION TO BE ACCEPTED f
Date: J II SCANNED Permit Number: 1 50 5- O ol1
BY
St. Lucie County
® �I' g�CE1�1ED MAY 1 '2015
Building Permit A►pplicatlon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: ftrLR-1
PROPOSED INP,ROVE�M/ ENT LOCATION:
Address: / L / I� • 1k,�✓ /
Legal Description: S ¢ e %i t �QC/1 f,�
Property TaxlD#: KOO, - 003`7— 000LotNo.379-3,R
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ETILEa,DESGRIPTION OF WORK
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CONSTRUCTI(QNLLINFORMATION ;
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers Generator
Total Sq. Ft of Construction: 'Sq, Ft. of First Floor:
l /J ad r It, Cost of Construction: $ utilities:,: S.pr _ Septic
—Windows/Doors
Roof
Building Height:
OWNERAESSEE ,,, ;;
"CONTRACTOR:',-,,
Name A A4-C�
+'Name: ' '.SC
11
Address: % g d 0 A/ • (� S p ll1 i
Company:/�tL// J-s1l%
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City: y c- `e State: '
Zip Code: Fax:
Phone No. 7 72 -777 '-(lo O
Address:<� .. A Y,
City: P0f:L tl Gt Stilte: E
Zip Code: 3 g9 3 Fax:
,Phone No. `/ 2
E-Mail: ,
Fill in fee simple' Title Holder on next page ( if different,
from the Owner listed above)
E-Mail: �2a
"e, S - ra /ildy
•��i
State or County License: J7 . lS 3 O
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
I
DESIGNER/ENGINEER: _ Not Applicable
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:
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 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 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 vour Notice of Commencement.
�G
Signature of Owner/Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORIDA
5 k. 1 o cry
STATE OF FLO�pA
COUNTY OF
COUNTY OF �i L-t.Le:00.
The forgoing instrument was acknowledged before me
The forgoing instru enr }vas acknowledgeoefore me
this�dayof f�q`# 20 by
this % daalyJoff - 12Y(I .20 � by
(Name of person acknowledging)
(Name of person TL,�
(Signature of Notary Pub' -State of Florida)
0 natur, q Notary Public -State of Florida )
PG`vEN�E�
Personally Known OR Produced Id Ica1+�N scab
@ers ally Known rq uced IdenitMaitiEiifNCH
Type of Identification Produced t• t_ Q° ae Eg5
,a�T Identification Pro ' <"a%;: Notary Puhlic - Slated
Commission No. E SQ1 ,.•rw,vue<%c'•..- �y Go 0'us �N����'a�
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n. : �^ :'_ My Camm. Eon�r�SFF n� (i9
Commission No. a: El5@�
i Notary Assn•
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
r
`'r/S
RECEIVED
DATE
COMPLETED
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