HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _ 11
Date: SCANNED Permit Number:BY
v Q J
St. LucieCou* 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: i
Project Name:
Setbacks Front Back:
[3HVAC UGasTank E]Gas
QErectric 0 Plumbing ❑Spri
Total Sq. Ft of Construction: _ "z o a
Cost of Construction: $�Ci�
Lot No. A
Block No. d
it Side: Left Side:
Piping U Shutters ❑ Windows/Doors
nklers 11 Generator 11 Roof
5 Ft. of First Floor: _
Utilities:Sewer F71 Septic
i�
Building Height: �_
OWNER/LESSEE:
.CONTRAAOR:
Name
Name CP/1
Addres : 0`1
Company C
•'
City: Oa c� State:.
Zip Code Fax:
Phone No. 7 %,2 • 2-b Z— 7
Address• o�i 5
City: Gt Statetge
Zip Code:,?�/ 9 If Fax: /J~
Phone No.
E-Mail: IN
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail A/S
State or County License:, 1-5,14 e,% d-" /✓��
it value or construction Is s2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTIONLIEN'LAW INFORMATION:
DESIGN GJIEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Add
20
Address:
City:
ZipaW_ Phone: /
State: s
-?8 - o7/ r' 0// 3
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 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
_ Si ature of Owner/ Lessee/Agent
ST E OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this- Wdayrof 20 _" by
ersooaRrr�Snown OR Produced Identification i
ea1c1, Notary Public State of Florida
Commission No. ti� racie L 95")
+� My Commission EE 159114
,00 Exoires011252D16
Revised 07/15/2014
Signature If
Contractor/License Holder
STATE OF FLORIDA �� pp
COUNTY OF �3T.
The fI oing instrument was acknowledged efore me
thisday ofnL
20 by
(Name of Olson acknowledging)
3�' J 4L"l
(Signature of Notary Public- State of Florida )
Commission
OR Produced Identification
bllc Slate[&Q;l1lade
Lamb
ission EE 159114
REVIEWS
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ZONING
SUPERVISOR
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MANGROVE
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DATE
6
COMPLETE
INITIALS