HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED'.' .'. APPLICATION TO BE ACCEPTED
Date:' SCANNED Permit Number:-
�:� �=_ BY RECEIVE®
St. Lucie Countv
Building Permit Application SEP 2 3 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:
PROP-_.OSE[Y NPROVEMENT•LOCATION,'.'': ._,__;'"•
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
-f
Lot No.2oH3
Block No.
_Mechanical _ Gas Tank _ Gas Piping _Shutters ' _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: 7? ' C.F Sq. Ft. of First Floor:
Cost of Construction: $ 9g 9, /6o Utilities: Sewer_ _Septic Building Height:
;000NER%LESSEE.:, �x
CORA NTCTOR
#.
Name 14eelloel PeI rZE
Jl
'Name: Cq aer,h. lOy¢ ✓CS
Address:'J(�'2/ -J L� /igCAd0r Pa-C
Company: ��(4yrJ L?i T
City: PS L State:j�L
Zip Code: 3`/ % S 3 Fax:
Phone No. 5&
Address: 33/ 9A-^ r,41d fi-OLe
City: Stater
Zip Code: 3 N9 i'S Fax:
Phone No r? a a / "`/%179
E-Mail:
Fill in fee simple Title Holder on next page (if differerit
from the Owner listed above)
E-Mail 00+'ef )k 1 //, S
State or dounty License 1:6C 1 /`/SW
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
UPPLE1t1ENT1_11111,11.Al°;GONSTRUCTIOfV LIEN LAWNFORMATIO'
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DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY:
Name:
✓Not Applicable
Address:
Address:.
City: State:
Zip: Phone
"City:
Zip:
Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
E/Not Applicable
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
commeneine work or recordirA-bour Notice of Commencement.
STATE OF FLORIDA
COUNTY OF
The for oing instrument was acknowledged before me
this day of Oe—+ 201� by
STATE OF FL
COUNTY OF
The fg9rrgoIng instrume t was acknowledged before me
this `b dayof dN 20�5 by
Dtaa� vve �h��1� f Owa� n� VP \\Wq5
(Name of person acknowledging) (Name of pe son acknowledging )
(Signature of Notary Public -
Personally Known"
Type of Idle rttificatiQ
Produced i- L %� ;j'�
Commission No.
- ��Vtu" Fronda
d tdAi9S°i�i� �5 Personz
hotacY,ExP�jes EE 555161 Type of
�m sYon # o�acY Pssn. Produc(
�ommcs„�nNaCrona�N
of Notary PubITc- State of Florida
Known OR
Commission No.
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Hotacl `E' 00, EE 555l5 N� ,romm 0
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REV EW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ASP
Rev.7/2014
FA