HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: � � Permit Number:
DECEIVED
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Building Permit Application MAY 1 B 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: To Select from dropbox, click arrow at the end of line
Address:15A.6 Mac Q I LW6 aer C CA TL 1 134-990
L gal Description: '� �L
Property Tax ID#: �gan-�o_N)y4-oaf Lot No.
Site Plan Name: Block No.
Project Name: \mmx
Setbacks Front Ba : Right Side: Left Side:
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itiona wor to e e Orme un er t�is permit-c ec a appy: � ���
HVAC �Gas Tank Gas Piping _Shutters �lindows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ `a , [) Utilities: Sewer OSeptic Building Height:
Name:
Address:\' \moi v1 LLa \, ::±eCO2JQ Q Company:
State:4� Address. � - o,
Zip Code:NIVO Fax: City: State:
Phone No-44a 7 - ) Zip Code: Fax
E-Mail: Phone No � - j'1
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:(`cc V5 1lg'fi
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SEPLEMNT ►1CN �R1� IQN,i1E1LAlttf�l) f�OR TON4 � �ry M k
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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:
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.
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA ° STATE OFTLORIDA '
COUNTY OF 1A6�t1� COUNTYOF
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The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this�day:of A 20Eby this: day of 20 PT by
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(Namegrson acknowledging) (Name of person acknowledging)
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(Signature of Notary Public-StA of Florida) (Signature of Notary Public-Statof Florida)
Personally KnownA ,;,•duced Identification Personally Known OR P o u, Identification
Type of Identification Pr dlfl�e Type of Identification Produce ::�•••'.':
Commission No. qfy�oCommission No. ,fSe&-
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Revised 07/15/2014 p4 qb�,�N�,�
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REVIEWS FRONT ZONING SUPER PLANS VEGETATION SEA TURTLE MA O
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIE
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