HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: yta� 1 �.'� Permit Number:
APR RECEIT-_ �.
2015
Building Permit Application
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:
PRQPOSI=D INP01tEME LOCATION£ °
4
Address
Legal Description:,
Property Tax ID#: 00 ` L'o Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTLC+N ( WORK f
/ r — "eE,%G �t $'s �/ �23/G/!
4Z
CONSTRUCTION INI=ORI�IATON a '>
A
a-_ . -
. ,
Additionalworkto a pe orme under t is permit—check a that app y.
_Mechanical _Gas Tank —,Gas Piping _Shutters _Windows/Doors
_Electric _ Plumbing _Sprinklers _Generator _Roof
Totaq, Ft of Construction: '( Sq. Ft. of First Floor:
Cost of.Construction: $ 12 w Utilities: ¢SewerSeptic Building Height:
OWf11Ei/LESSEIa z'� ACT RRA
CON
Name E Company:
i Name:
Address: j�Z ,¢ ..� ,' f t
City: State:,, Address: L
Zip Code:_ •DOD�Fax:"t City: State: L
Phone No. Zip Code:sig '"Z L Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
L4
EM CQNSTRUCTtpN LIEN LAW INEOFtMATI�}N1
1 k
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: 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_Wcordingyour Notice of Commencement.
Signatu , of Owner/ gent/Le ee - Signafi re of Contractor/Licen older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 'S r - LN)c COUNTY OF Sk, 1-Uz
The forgoing instrument was acknowledged before me The forgoing instrumen was acknowledged before me
thisa day of 20 155 by this a\ day of 20L5 by
(Name of person acknowl dging) (Name of person ackn ging)
(Signature of Notary PuVic-State of Florida ) (Signature of Notary P lic-State of Florida )
7 01M.15 F\000
��`� 1 6
Personally Known OR Produced Id �(�r$(fc\O\\ �6 Personally Known OR Pr ick 6?�,
Type of Identification Produced 1- �Q �P. �a�e �6 Type of Identification Produ L-13Jt*? cess° 5® o
Igloo
Comm �pUB!c•�N° GCO°pc\��Gs-�ode�a��`or ;u. G Pue•, •:c My � �t
°
Commission No'
v ,
Ni h�N.a\gyp°a
\N°
�G• •G� aQ, , VIII 111 ,
REVIEWS FRON •a F .1 SUPERVISOR PLANS VEGETATIO SEA TURTLE MANGROVE
COUNT - W 'REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
-Re-v—.7/2014