HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONP-
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y
Date: �" ��' )� SCANNED Permit Number:
v BY RECEIV
® S4. Lucie Count, MAY 2 2 2015
Building Permit Application
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: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPRO,V.EMENT LOCATION:
Address: /i 7 F S. ll S
Legal Description:
Property TaxlD#: / — 5ba2 -
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Site Plan Name: 16e,
Project Name: ASi� Digs —
Setbacks Front Back: Right Side: Left Side:
,DETAILED -DESCRIPTION OF WORK:
Lot No.�
Block No. ?_
CONSTRUCTION INFORMATION:
LT
'
Mona topenerformed under tis permit— check all apply:
��OHVAC Gas Tank EJGas Piping _ Shutters
l'lectric 0 Plumbing ❑Sprinklers Generator
Total Sq. Ft of Construction: ?D S Ft. of First Floor:
Cost of Construction: $ r,` S� , j Utilities:[]Sewer "Septic
❑ Windows/Doors
Roof '
Building Height:
OWNER ESSEE:
OR:
Name
Name:
Address• 2
Company.
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City: 7i r tc ii State
Zip Code: ��,� Fax:
'7 Phone No.'7 a ' -Z D /— 7 53
Addressn,,:,,,
City:•oy . OVU44
Zip Code:-? f�Z%�z Fix: _'Vr'�
Phone No. �07/ g
) State
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E-Mail: .r
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail S/iPA 5 3k<�f
State or County License: y3 5-t/
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11 Vd1YC Vf conSLruGnon is i1z3vu or more, a ntwnutu rvonce or t.ommencement is required.
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SUPPLEM
ONSTRUCTION LIEWLAW INFORMATION:
DESIGNE
Name:
GIN R
_ N t Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Addr s:
4
Address:
City
Zip:
t_:
Phone: —
State:-
— 3 it
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.
no
,e 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
commencing work or recording your Notice of Commencement.
_ Stature of Owner/ Lessee/Agent / J Slgnature�pfContractor/License Holder
STATE OF FLORIDA STATE VOF FLORIDA
COUNTY OF - COUNTY OF moo.
The forgoing Instrument was acknowledged before me
this day of� 20 Lby
C
The for oing instrument was acknowledged before me
this day of 20 IS by
,Personalhf_fnbwn _ OR Produced Identification
Commission No. °# gF Ex pires ComppjasigP016 EE 159114 Commission No. •+j4r"'k NotaryPublicLathii"�yyq }Rondo
Excie L
My Commission EE 159114
Revised 07/15/2014
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