HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 's �15 Permit Number:
l,. RECEID MAY 211015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fart 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
PR{3PUSEDIMPRQVEMENTrLQCATIQN
Address:
Legal Description:
Property Tax ID#: y - ob b ,- 4d o-- Q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OI= WORK` r
"100 1401P M"�J
COISTRtlCTIOiV IN.FORIIiATIC}N
r
. . �._.. _
Additional work toe e orme under this permit-Check a appy:
HVAC F]Gas Tank F]Gas Piping _Shutters F]Windows/Doors
17 Electric D Plumbing OSprinklers Generator 0 Roof
Total Sq. Ft of Construction: Sq. Ft.of first Floor:
Cost of Construction:$ a C?(), G0 Utilities: Sewer Septic Building Height:
0111oNER/LESSEE f r LON 9/il'76r■{JR` r 4 ;
'Name,.
Name MAd) Me- j aE-d
Address: 6111r Iq(r l E 1 t QA. Company: 9--aorL,( 'oj gi LCA t
City: -0-/-660?6-as- State: C Address: 41 `� .SC-"-G�`�ax k k,(.
Zip Code: .3 Al fffZ Fax: City: P-se j State: t�L
Phone No. 797-2-S_ fl03 1 Zip Code:. Fax:
E-Mail: Phone No. .3 q).- ;.v C
Fill in fee simple Title Holder on next page(if different - E-Mail: �i A-A kr l 41:�yg'-I 'g f a ce-'-*7 _
from the Owner listed above) State or County License: 3 0
If value of construction is$2500 or more,a RECORDED Notice of commencement is required.
IONSUPPLEMENTAL COISTRUC3HIEN LAt1V INF(3RMATICJtV
�. a t„
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.
72C2__�_�_ s
5 ature of Owner/L gent Sig4efure of ContpztarlCicense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF '5-�. Ly e \A" COUNTY OF 'S k.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisa\ day of `M" , 20 1by this Q.\ day of m O.� ,20 IS by
73\0m 5 ire
(Name of person acknowledging) (Name of person acknowledging' )
(Signature of Notary Publi tate of Florida) tyti�s da (Signature of Notary blit-State of Florida? y
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Personally Known OR Prod u d T��o o,b 6� Personally Knowq OR Pr leAsibm fro 0p6
Type of Identification Produced 1-45 .1-�g rso ype of Identification Pr L 1c Dao �1
0 �' n .rrY PUg••i ¢�
�rrriYuhr N (ic•4w
Qum,�
Commission No. - °:, `1 9 .�Eommission No. G l_ •_ c�R s air t�
. dry( b°0� `lN�Y G°'+""o��N o�
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS