HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONE
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' 2� l� SCANNED Permit Number:
BY
--- St. Lucie County DECEIVED
Building Permit Application MAY 22 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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED_ IMPROVEMENT LOCATION'
Address: /671 7 R,54-
Legal Description: X/�
Property Tax ID #:
57
Site Plan Name: n- N�
Project Name: t
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No. 11
Block No. �—
CONSTRUCTION INFORMATION:
itiona wor to e e orme under tispermn-checka apply:
0HVAC 0GasTank E]GasPiping _Shutters ❑Windows/Doors
Electric 0 Plumbing ❑Sprinklers I-] Generator Roof
Total Sq. Ft of Construction: aril 5 Ft. of First Floor:
Cost of Construction: $ 2 6�f! , 0 a Utilities: oSewer Septic Building Height:
OWNER/LESSEE:
CONTRACT R:
Name AVU,L
Name
Address: i
Company:
e'0 ,
City: Wht2X, State:_'
Zip Coded C/ q 5 Fax:
Phone No. 72,2 - �'_t9/ -y"775 3
Address: ,3,) Ir
o �•
Cityti,�
ZipCode:s _Fax:
Phone No. z/Y •-' 4
State:
7/ 8
E-Mail: '`
Fill in fee simple Title Holder on next page (if different •
from the Owner listed above)
E-Mail• oS)& N S 30
State or County License: �7i�
Z✓rB�B /�'�
IT value oT constrUctlon is y251111 or more, a RECORDED Notice of Commencement Is required.
'SUPPLEMENTAL ;CONSTRUCTION .LIEN"LAW' INFORMATION:
DESIGENGINEE
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: /,2,00
Address:
City: t
Zip��N 3 a Phone: i-S$
State: ,
` ?1—e) /67J
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 ppermit 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 concurrencV 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
_ Sig ture of Owner/ Lessee/Agent
STATE OF FLORIDA C --I
COUNTY OF , e e
The forgoing Instrument was acknowledged before me
this day of M4
20 IS -by
Notary Public -State of Florida
Commission No.
Revised
OR Produced Identification
Public State of Florida
Expires 01262016
- s
5igna 7
re of Contractor License Holder
STATE OF FLORIDA �pp
COUNTY OF 5 . .l, d
The foing instrument was acknowledged before me
thi�dayof "," 20 J by
(Name of da4son acknowledging)
Lop r�
(Signature of Notary Public- State of Florida )
own OR Produced Identification
Type of Identification Produced
Commission
of Florida
My Commission EE 159114
Expires 01252016
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