HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
RECEIVED
Building Permit Application MAY 19 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
PROPOSED IMPROVEMENT LOCATION:
Address: 51PU agh r2ri e a Nftr&
Legal Description: 34oa -1,oDq - oien 'oco-&
la'LA JJJPY C%sW:S -L)A iFoA - E�m14 51 Lc*dy/ I'Ylq jg 3yY d 3al b
Property Tax ID#: Lot No.do )��
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a appy:
HVAC 11 Gas Tank ❑Gas PipingMGenerator
Shutters Q Windows/Doors
11 Electric E]Plumbing Sprinklers Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ I ,�yO L Utilities:i Sewer E Septic Building Height:
OWNER/LESSEE: :CONTRACTOR:, .
Name LAIk .e LID '11 Name: U, 6<, POW
Address: Wil oauL Company: Y(auPAp f-, &-2A1,� L<&V141
City: - AeIu 117--u State: 't. Address: _341 6i Sf-K-� Az11e-
Zip Code: Fax: City: PA a wu d, State:
Phone No. d- WZip Code:3` 1� 3 Fax:
E-Mail: wia-c, C'0 r-11 Phone No. 7-ICA -LAJI -4061)
Fill in fee simple Title Holder on next page(if different E-Mail: Vim Gh�
from the Owner listed above) State or County License: L
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. A 917?
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SUP,jEIVhENTALCO.NSTRUCTIO.N LIEN„LAW INFORMATION
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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 thepermit 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, con i��n attorney before
commencingwor or ecordin o r Notice of Commence t
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—Signature of OnV Lessee/Agent Signature of Contractor icense Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF .�U l r1 L.U CI COUNTY OF S 'T'. W U C
The f r oing instr ent was acknowledged efore me The forgoing instrument was acknowledged before me
this:day of 20 LIby this l�3 day of AfA 20 L!�_by
CV1 r 0 tkv Qr S
(Name of persona kn ledging) on John spas (Name of per on acknowledging)
Notary Public /
State of Florida
(Sigot(tA of Nota - (Signature of Notary Public-State of Florida)
Expir®s;Augi at 18,2
Personally Known OR Pr duced IdensUation Personally
Known OR Produced Identification
Type of Identification Produced �_ Type of Identification Produced A�
Commission No. f� �0� .�(� (Seal) Fedon John C mission No. n a RUBENl9 VALLS
Notary Publ c g�� ®� Notary Public,state of Flo i
Revised 07/15/2014 State Of Florida My comm.expires Jan.17, 6
MY COMMISSION # FF 30236 n , .
Expires.August 18, 2017
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DATE
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