HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLICABLE INFO aMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c
Date: SCANNED Permit Number:
n BY
St. Lude County RECEIVED
Building Permit Application
Planning and Development Services MAY 2 2 2015 60
Building and Code Regulation Division l/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial V"' Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
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Address: /0 76 -f Aa-5 S. �. ✓�P55 a
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Legal Description: GI�64
Property Tax ID #: �J/J J"a —S-0 / ASP e a D e Lot No. /f
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
I_iHVAC L_J Gas Tank UGas
lectric ❑ Plumbing ❑Spr
Total Sq. Ft of Construction:
Cost of Construction: $ 25 5 0 . D
Piping L_l Shutters
nklers ❑ Generator
_ S Ft, of First Floor: _
Utilities:❑ Sewer ❑ Septic
Windows/Doors
❑ Roof
Building Height:1� a ,
OWNER/LESSEE:
CONTRACTOR -
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Name:
Addre,s�[ns�
Company IcA�L
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City: Y e c- State: 2
Zip Code: Fax:
Phone No. %7 0 / V 53
AddressOR//
City: G(2Gc
Zip Code:
Phone No.
State:
Fax: �✓lG P ��J�`/
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E-Mail:
Fill in fee simple Title Holder on next page (If different
from the Owner listed above)
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State or County License: 1-4
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If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN STRUCTION L'IEN'LAW INFORMATION:
DESIGN NGINEER: _Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: �:7-
Name:
Address: 98
Address:
City: State:
Zip: Phone: — f — f — 3-/-/ �5
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or angcovenants 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 recordin our Notice of Commencement.
1. F/YV�y
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_ Sign fure of Owner/ Lessee/Agent
Signature of Pntractor/License Holder
STATE OF FLORIDA�
COUNTY OF ' Pao
STATE OF FLORIDA a
COUNTY OF
The forgoing instrument was acknowledged before me
this day of" /� 20 by
The forgoing instrument was acknowledged before me
tW day of G 20 /� by
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(Na e f person acknowledging)
(Name acknowledging)
o
�pje(rsoonn
(Signature of Notary ublic-State of Florida )
(Signature of Notary Public - State of Florida)
sona_lly Kno OR Produced Identification
ification Produced
ersonally Known OR Produced Identification
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Commission o�+"`r"2a Notary Publa�ibateo'e
My Commission EE 159114
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Commissi y��QPbte of FloTidde
` ,limmission EE 159114
a' 01f25i2016
Revised 07/15/2014
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I 116
INITIALS