HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U 3 - J Permit Number:
,�.. . . RECER"--D JUN 03 2015
Building Permit Application
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
PRO:P®SED IMPR01/EMENT LOdCATC®N: 110
Address: `/D 5 llL f ,�� u -T ,4/'e pez4 / -3 el- 57
Legal Description:
Property Tax ID#: �� , �O — a�a -- a C d ^3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CON�S�TR+.IJCT'I,OIU [N�F®RaMATI®:N: -
��itiona workto e e orme under this permit-check a appy:
LJHVAC Gas Tank' El Gas Piping _Shutters Windows/Do.ors
Electric ❑ Plumbing [:]Sprinklers Generator ❑ Roof
Total Sq. Ft of Construction:. Sq. Ft. of First Floor:
Cost of Construction:$ U Utilities:0Sewer❑Septic Building Height:
#®UVNER%LE�SS'EEr C®NTRACT®'R: A
Name
JName:
Address: '��/0, 6-2165 1�'/L. A 1/Lr Company: F
City: 2- I to/6- State:-21 Address:
Zip Code: I 51—/ . Fax: City: State:
Phone No. 2 77 l Cf ' 1- Zip Code: Fax:
E-Mail: 7edl iAfU/4 C9N(-- _H,9 i 1/7Y1 CPhone No.
Fill in fee simple Title Holder.on pext_page(if different E-Mail:
from the Owner listed above).. State or County License:
If yalue of construction.is$2501)or.more,a RECORDED Notice of Commencement is required.
SUPP4i3EN1ENTA CCINS�TRU I®NILAUV INCiRMr4�Tltj[ .�
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.
s
_Signature of O er/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Theoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
forg
this day of J 20 Eby this day of 20 by
�c �'Z �cv.k�,n5
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu c-State of Florida) (Signature of Notary Public-State of Florida)
IVENS ersonall Known OR Produced Identification
1.Personally Known ,s ce Iden®ffiL��b�i id Y
Type of Identification Pr uY�P�B••, ublic-S.tat m01 pe of Identification Produced
My comm. xP' EE 858161
Commission No. L� .oe (g )n�ssihNa�ona1%oJatV Asn mmission No. (Seal)
e of f e?• Bonded Thtoug
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS