HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / v ��IJ SCANNED Permit Number:
BY
S at. Lucie County
• RECEIVE
Building Permit Application
Planning and Development Services OCT 12 2015:�
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: 1 0 IC; 2 S QC6f:N-N 71� _n
Legal Description: ATe.r�rri c CoNoe-m f o(a 17 oNt'r 1(9 0 A-v0 P?o -rOwT-4
S [121- a- I N C an't n or CGe714, C.-' /% t o h.. %
Property Tax ID q: 2' Aciog - co, �,o, —ee �� Lot No.
Site Plan Name: _ !R'Y )S �� Block No.
Project Name: �fton5/J
Setbacks Front N A Back: _i�4_ Right Sider Left Side:
DETAILED ptSCRIP„TIO'N OF W,QkK.:
CONSTRUCTION INFORMATION:
AcIclitionalworKtobe erformed under tispermit-check all that apply:
OHVAC Gas Tank []Gas Piping _Shutters ❑ Windows/Doors
11 Electric 0 Plumbing []Sprinklers Generator L Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $. /'� 1W Utilities:
Septic Building Height:
-OWNER/LESSEE. . ----
-'CONTRACTOR: _ -•.-
-- - �T ,---.
Name Y — - N r
Name: %Gwl__-
Address: /0 /�Q <' n� ✓G
Company: TE>Lsry L
City: 7ehftsv 9c� State: 1Z
Zip Code: 344;7 Fax: N Pr
Phone No. p_ZT
E-Mail:
Address: / o /V..v
City: ;tl-' State:�2
Zip Code: Fax: .D5'z-5-7-f
Phone No. ! Z -G%Ci()—��
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: i G/
/9V ry "L
State or County License:
C /
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPL M0T- AL Gd" ' RUCTION`UEN LAW INFORMATION:, ` '" a'
n
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 inspectign. If/yW intend to obtain financing, consult with lender or an attorney before
of
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sr Lf%c!F COUNTY OF _G'T
The forgoipg instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ay of �' Fib 20l`„Lby this/"�aay of ��"TlJ/viE.L .20%by
(Name of person acknowledging) (Name of person acknowledging.)
(Signat Jotary Pub is -State of Florida) (SignaturevFNotary Pub'c-State of Florida )
Commission
11 AA. P&I ANN GN MDNDn 11
EXPIRES: December7. 2018
Revised 07/ 15/2014
Commission
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