HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
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Building Permit Application JUN 10 X015
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
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PROPQSED IMP:R01/EMENT.LOCATION
Address: tU� `1 /_ e All—
Legal
/Legal Description: ' 4L221 - dZ222 a_
Property Tax ID#: A4 'IyoYv2 ` 09 9 ODl1 — Lot No.
Site Plan Name: &/,LI�Q'1'I &f? Block No.
Project Name: Gc
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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44
CONSTRU_' 0 ' INFORMATION'S
A itiona wor,to beperformed under t isermit
p —c ec ,a appy:
❑HVAC'-'
., Gas Tank Gas Piping Shutters awindows/Doors❑ p g
❑Electric ❑ Plumbing ❑Sprinklers ,❑Generator ❑ Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ �J CrD LitilitiesInSewer[]Septic Building Height:
SS
MA CONTRACTOR
Name iS6L 5 �G�►.OLk'C7,Y,Lf" Name: ut�S E` :T•" A, �::�.�
Address: 101)7)q 4"'�- Company: S ��
City:TL 1 �L,�i!(� State: Address ���
Zip Code: Jq 17 if 2- Fax: �- City: :lam/ 4" Stater
Phone No. 561— 2I'2- - too S Zip Code. Y.7t/5-g Fax: /- �r?'/ - 7%75'
E-Mail: Phone No._5.6/— 2 Jr 2-0q s
Fill in fee simple Title Holder on next page ( if different E-Mail:
from the Owner listed above) State or County License: jZ$'7K P"6-
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPTLEMENTA�L CONSTRUCTION.LIEN LAW INFO,RMATION.,
:.
DESIGNER/ENGINEER: 1V Not Applicable
MORTGAGE COMPANY: 1Not 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 op recording your Notice of Commencement.
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_Signature of Ow er/Lessee/Agent N Signature of Contractor/License Holder
STATE OF FLO IDA 1J// LL� STATE OF FLORIDA
COUNTY OF Qf "� I%z�= COUNTY OF f
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The for oing instrument was acknowledged bEfore m s U3 The forgoing instyumaent was acknowledged befor a if
this day of�" i 20 by ¢� g this day of(!)) t. .� i 20 by `
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(Name.of person acknowledging) , ame of person acknowledging)
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nn : /�-r �� "�/Ir 1 l?
(Signature cif Not:ary Public-State of Florid (Signature�o. Notary Public-State of'Florida )
Personally Known OR Produced Identification / Personally Known OR Produced Identification
Type of Identification Produceddj6.• ^ _ Type of Identification Produced , - /1,,;
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Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE-
COUNTER
ANGROVE-COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS