HomeMy WebLinkAboutBuilding Permit Application A
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �a \5 Permit Number: Sb5 03S rj
w - RECEIVED APR 161
015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 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: lur(S e)L—Vb
Legal Description:
Property Tax ID#: q 5001_50 j— to,"— Ow-I Lot No. Ott
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIOUCIF WORK
1 6KPOMY ALf_ mcke--�tv �9-' rA
CONSTRUCTION INFORMATION:
itiona workto e e Orme under this permit—check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
UElectric El Plumbing Sprinklers E Generator 0 Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 5W Utilities:0 Sewer E]Septic Building Height:
OWN ER/LESSEE:,` CONTRACTOR:
Name SAM 1✓_rpf L Name: Afimup,
Address: Company: 40A4XC,#1 # Ti1,6
City:_fhcpl�,&CWJh, State: j Address: .Z" gddr L
Zip Code: ON E Fax: City: h*� 97-,(.mum_ State: 1r1__
Phone No. ao Zip Code: 34q�o2 Fax:
E-Mail: Phone No. 1"79L'" 37Q-57S�
Fill in fee simple Title Holder on next page(if different E-Mail: W9ANC9 `RAI-, 0&-r
from the Owner listed above) State or County License: E C(_"3072
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEWLAW 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
improveme,nls to your property. A Notice of Commencement must b recorded and posted on the jobsite
before th f' st inspectio . If you intend to obtain financing, cons ith lende an attorney before
comme i work orWording our Notice of Commencement
Signature of Own /Agent/Lessee Signature of Co actor/License Holder
STATE OF FL RID�4�Y c STATE OF O. IDA
COUNTY OF 1 e COUNTY
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this %G day of Ck C 20 lib by this \ day of aT20 by
(Name of person acknowled ng) (Name of person acknowledging)
as `
(Signature of Notary Pub c-State of Florid �aP e,�a e° g1 PSS ignature of Notary Publi -State of Florida)
� O h
Personally Known OR Prod d Id e id . oar Personally Known OR Produced Id *.
Type of Identification Producede of Identification Produced t- �� o�� 20
„uugigi �.� God 1r�° OSP��c' SOe° 506 SSo:
Commission No.L i��S `••'Q�Seal�ae� Commission No. 45$1 p �1QIle
)e �cE N°�aNP
Li• •C � .- "l ,uuu4 `o stn• .\00 °�a�
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIO SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS