HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONZ
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -S ::�Q • 1J' SCANNED Permit Number: �J V� ' V's V o
BY
St. LucieCounty RECEIVED
Building Permit Application MAY 2 2 2015
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 t/ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address:
Legal Description:
Property Tax ID #:
Site Plan Name: &�
Project Name: alp
Setbacks Front Back
S
--)0a
Right Side: Left Side:
Lot No. h'
Block No.
('DETAILED DESCRIPTION OF WORK: {11
/— 0'A/e `Gl%%ll
INFORMATION:
I1HVAC LiGasTank E]GasPiping UShutters
gti/ectric 0 Plumbing �) ]Sprinklers Generator
Total Sq. Ft of Construction: _ y ?I 5 Ft. of First Floor: _
Cost of Construction: $ 11 D O 0. O �i Utilities: Sewer Septic
❑ Windows/Doors
DRoof
i
Building Height: Ile ",2 rr
OWNS /LESSEE:
CONTRA OR:
Nam
Name
Address 2 1�' e '
Company:'
Co , itd v
City: . Pp . S. L • State:
Zip Code: 34 16 2 Fax:
Phone No.QB /— 7 $ 63
Address: & )
City I JQ62 Le.
Zip CodeRq Q Ama Fax:
phone No. Z
Stater'
' -1.11 5 `7
'?
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: QQ N S 3� &
State or County License: Yaw
E7"- i9 d 1S-j
IT vaiue or construction is yzsoo or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN' LAW'INFORMATION:
DESIGN N JN R: _
Name:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Addre s: Z�TJ
Jb a
Address:
City:
Zip' Phone: /-V'FW
ate:
-,J1 r4-311
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
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 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
commencins work or recordine vour Notice of Commencement.
_ Stature of owner/ Lessee/Agent
STATE OF FLORIDAS . J
COUNTY OF
The fgfgoing instruTent was acknowledged efore me
this day of t_- y-yy ,. 20 by
of
icie L Lamb
Commission EE 1 fNA
Revised 07/15/2014
Signature V
Contractor/Licen a Holder
STATE OF FLORID
COUNTY OF n
The forgoing instrument was acknowledged efore me
this day of Lt 20 �? by
(Name f person -acknowledging)
.' �4�
(Signature of Notary Public -State of Florida )
i Mr Cun:qusss.eA5511i4
Commission N •f'
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