HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' �1• I S Permit Number: 0Sa7
01 RECEIVED
Building Permit Application MAY 21 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
PRQPOSED,IIVIPROUEME;NT LQCATIgN
Address: C1059- 5hn,14 ChU2
Legal Description: L . �3_ ZR,L 5
PropertyTax lD#: 333LI^ 501 D)qZ)-b®n Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION.f.OF,WORK
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CONSTRUCTION INFORMATION
Additionalworktoe a orm.. , >..
e under this permit—check a that apply:
HVAC ri Gas Tank Gas Piping FIShutters Windows/Doors
Electric El Plumbing Sprinklers 1:1Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Q&72— Utilities:0 Sewer F Septic Building Height:
OWNER/LEZFE:'. ;CONTRACTOR: ,
NameDng l d lQu_Ap I F Name:_W i rime. QLbnad t
Address: qQ5,') 1r-1 T 1 Q C1 Company: ('nr7-1-rAen LLC
City: PQ(-+ Si- Luc(e_ State: Address: 912;5 S wf�a
Zip Code:,:�LIq LP Fax: City: PO a 54 L(,(_CU State:rL
Phone No. `{b?, 312 — .2 5AP Zip Code: 3453 Fax: 613P -93:3-01 6-7
E-Mail: Phone No. ?72' 105 --()200
Fill in fee simple Title Holder on next page(if different E-Mail: 311 P.CPIn eu'l corn
from the Owner listed above) State or County License: 1701
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S=UPPLEMENTAL CONSTRUCTION LIEN I.A1N INFORMATION£
=
DESIGN ER/EN GINEER: _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.
'_A/ S
Si ture c f Owner/Lessee/ gent Sigliature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA -
COUNTY OF 5-� Lil Ll COUNTY OF ,5-� 1,.,u (.f e,
The forgoing instrument was acknowledged before me The forgging instrument was acknowledged before me
this,&day of VY)cue 20 S)_by this day of m 0Lw20 by
M1 bad D'h0hn&.I
(Na f rson a nowl ging) (Nam of p son acknowle ing)
(Signature of Notary Public-State of Florida) (Signature of Nota Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Pro ype of Identification Pro ucekYo •..
GALE FULL.E
a 2�4p�B�C ((
t.7 1 i� f°w4w11'�...'R
Commission No. - MY,�(vIISSIONi v45'
EXPIRES October 20.2017 ommission No. �'IY�(��I�Sglp,�)rFFD84558
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EXPIRES October 20.201 (aoz)398-0153
(407)398-0153 F{oridatJotac}eS 'Jue.co
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Revised 07/15/2014
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