HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �/
Date: (O —��(�� Permit Number: km,(,• C) I I
RECEIVED
Building Permit Application JUN -8 2015
Planning and Development Services
Building and Code liegulation 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 Y
Address: dd o t6 V-1 e r 3
Legal Description: �t �.�, rl'i �S h S� Lal TVk (M �'1�`75
Gr /G L 3- azL- ss �-5`�3 I S
Property Tax ID#: 0 O 0 O Lot No. _
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPtION QF WORK r
b34 ct_�P_s
CONSTRUCTION INFORMATION -
Additional_ wor to e performed under this perms -
. - .- ,.. permit—check a apply: ..
❑HVAC E]Gas Tank Gas Piping _Shutters a Windows/Doors
Electric Plumbing Sprinklers F�Generator Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ /6 ,00 Q� Utilities- Sewell Septic Building Height:
OWNER/LESSEE :;CONTRACTOR _
Name AzIl, -q Name: c¢ C
Address: r70 e l Company: 14(kcc,
City: F fi Vt State: C- Address: C 03 F ft-- 4
Zip Code: 3 C(C1� Fax: /1[� City: FTf avc-P, —State:
Phone No. Zip Code: �f t Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: K tyk& ce U� �eCJI <zi
from the Owner listed above) State or Coun 'cense:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION: -
-
DESIGNERANGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 Counter 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 1 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.
s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORID '
COUNTY OF / COUNTY OF
The f.. r oing inst nt was acknowledged be The fo oing in ent was acknowledged befoi - m
this day of 20 ' this day of 4, 20 IS ny
i Mr.
(Name of person acknowledging) Ny go of person acknowledging) 9
$ o
2 m
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(Signatur Notary Pu Stat of Flori ) a N (Signature of tary Public-State of FI rid
ho- a)
Personally Known OR Produced Identi Personally Known OR Produced IdentifitA
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
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