HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED G
Date: -4 3 5 Permit Number: �5d��bOl 1
�5 :.z RECEII. =D
AUG 0 3 2015
SCANNED
- ---- Building Permit Application BY
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: � 1
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Address: 3100
Legal Description:
Property Tax ID #:
Site Plan Name: _
Project Name:
Setbacks Front
-3aa—o00 a.-0
Back: Right Side: Left Side:
_Mechanical _Gas Tank
)a Electric _ Plumbing
Total Sq. Ft of Construction: -
Cost of Construction: $ a I Do
permit— cnecK au tnat appy:
Gas Piping _Shutters
_Sprinklers _Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Lot No.
Block No.
Windows/Doors
Roof
Building Height:
OWNER?/,LESSEE:
CONTRACTOR:
Name UVT PowGNP'
Name: %OC NC. —r C�
Address: ) 3 410 d
IJ 00(k
`I �/
Company: ,� K --
City: UPrd *,&k
Zip Code: lql,�L_ Fax:: 772
Phone No. y — 1'lC 3 O
State: r=I
71 C/ I510
Address: 3 S !%
v
City: r—l. I , r State:_��
Zip Code: 3ti ti q:J Fax: g6rG 6s--gp
Phone No.%6-05-00
E-Mail: ' N k—
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: `ZJ I nQvi t / KC 'P 0
L(/l'
State or County License: EL 1300 5_ O
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SARPL NATAL CONSIT' R ION, MEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
commencing work or recording vour Notice of Commencement.
C,t_4 _a�
4�_ 4W_LL -
Signature of Owner/ Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLOR DA
COUNTYOF St,Lye%�
COUNTY OF LV�t�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of q J 20� by
this 3 day of Q V� 20�5 by
mac: c Le�t�,1i h9 a�
<_(,\c LeAdof v,�eaJ
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary P lic- State of Florida)
(Signature of Notary P lic- State of Florida )
NS
Personally Known OR P edi iitiB�o"otb
Personally Known InL�iftci��gl pwrida
Type of Identification P f so c , sna0 6t
Type of Identification uye�(, t ),J4W is • S a E Zo
room.\ E Ass
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REVIEWS
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'SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.i/iuiv.