HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FORAPPLICATION TO BE ACCEPTED
Date:I I oZ,I 15 Permit Number:
RECEIVED MAY 12 2015
M Isom W-40 r
- 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 b'
PERMIT APPLICATION FOR: f,'�f I;z,+
PROPOSED INRRO�IEMENT LOCATION: � : ,
Address:
Legal Description: i JU
Property Tax ID#: 419b 4ML DUB 006 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D£ CRIPTION OF WORK:
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COIVSTRtJCTION IiNFORMATION:
itiona wor tobeperformed un er t is permit—c ec all tat appy:
Mechanical _Gas Tank _Gas Piping _.Shutters _Windows/Doors
—/Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction:$ �0 > Utilities: —Sewer _Septic Building Height:
ODUNER/LE�S�SEE: C®�NTRAC�TiO,R:
Name /V£ Name: ND/.t
Address:' a44. 'f Company: Alow
City: State: Addr ss: 6 9IS C t
Zip Code: &I&I Fax: City: u State:-E—L
Phone No. `7702 ago/-g971 Zip Code: Jg94D) Fax: w- -W
E-Mail: Phone No 771-A!-W16
Fill in fee simple Title Holder on next page(if different E-Mail RAV I& ./,ADL- &44
from the Owner listed above) State or County License 0-k
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJPPLEMENTJI.WN-S;IR+IJCI"ION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: Stater 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 recording our Notice of Commencement.
4: k A4�� 4a��
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this l2_ day of 20_)S by this12 Z day of Mftsi 20� by
(Name of person acknowledging) (Name of person acknowledging)
A
(Signature of Notary Public-State of Florida) (Signature of Not ryPublic-State of Flo cla )
Personally Know .......,jPR PrcOtte GOINIiESOM Personally Known . L4
Type of Identifica . ` Notary Public-State of Florida Type of Identificatio .tip NY PVB,�' SALLIE WILSO"7F KESNER
Produced _•. .• My.Comm;:Eicplres Nov 2,2018 Produced ?_°. .`� Notary Public-State of Florida
Ps.=
Commission#FF 148194 yComm.Expires Nov 2,2018
of F°',•• Bonded Throu al Notary Assn. a;
commis 148194
Commission No. Commission No. ,F°FFA°.�' ondedThrou aidnalNotaryAssn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014