HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S Permit Number:
- ' RECEIVED
Building Permit Application
Planning and Development Services MAY 21 2015
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,INIPRQ,VEMENT LOCATIQN
Address:_(oqn D I e a r-( .e s PVQ.
Legal Description: q 310 4o 0 1/2 n-f- SE i/,1 of SC- Vit- I esS -61-_3 pL
W u34aoW- 6o.o�i �
Property Tax ID##: 3LkQq— 4LII" Uon 1—l)n0- U Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
r-'(D k ac-e, lP w t Rdow s size floc s i z e-
CONSTRUCO 'INFO_RMTIQN
Additional workto e e Orme under
r t is permit—checkMrhutters_ p
py:
HVAC 11 Gas Tank Gas Piping Windows/Doors
11 Electric 0 Plumbing Sprinklers 11 Generator Roof
Total Sq. Ft of Construction: D SFt.of First Floor:
Cost of Construction:$ '1�4Z�2 Utilities:.Sewer Septic Building Height:
OWNER/LESSEE " " ; CONTRACTOR':
Name ory'ie,I0. l28hP,(-)S Name:AA kckhae.1 pbo nne U
Address: loq n,S rI&in c,I P C Ave— Company: Q_J)o n ne_tl COt'kacheya L.C,C_
City: - PIQ Yc_e. State: Address:��35 Slh� ���nrk� F}vo
Zip Code: Fax: City: POCA- 14 LU CLQ State:
Phone No. Zip Code: 3q T53 Fax: 5813'R33-01 (o?
E-Mail: Phone No.17D 08—02-00
Fill in fee simple Title Holder on next page(if different E-Mail: rUnckpnAe_\\ 3 @ e�cYlcu I •CC)l'�
from the owner listed above) State or County License: 2--70 7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SIJPPLENIENTAL GONSTRtJCTION LIEN`L:A1N INFORMATION
. ... ,
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
commenizing work or recording our Notice of Commencement.
S
_Signature of Owner/Lessee/Agent gnature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sk Llu I -e COUNTY OF 41— WC I e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,jZ day of M aA-J 20 aby this4 day of M&Ld 20 I5 by
Mkt. nel O 'Ibonnl°1 l (W b')Q AnP l (
(Name of person ackno edging) (Na a of pe son acknow ging)
(Signature of Notary Public-State of Florida) (Signature of otary Public-State of horida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
,.,.San�p� AT.I
Commission No. „„Y.p�,, SeaI��LE FULLER Co mission No. e°�'; !MM
FUL;op.........a�;•. LER
A•1y ISSION+FF064558
• MY COMMISSION FF06 558 ,._,-
q; o?: EXPIRES October ctober
) ` - 'iass-o,;3Revised 07/15/2014 (ao°7f°3980,;3 FlotdatotaryService.cotao
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