HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / -�
Date:�� / -J Permit Number: ` ,5 (� ' y a r f
RECEIVE
- -- JUN 12 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 Commercia Residential
PERMIT APPLICATION FOR:
PR`OPaSED fNP'R0�/EMEN
I'M NS
Address: 7b3C� S• FE_Dc- M, �ic�wa� �� C� 3 yg5e,
Legal Description:
Property Tax ID#:3ya 00 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DESCRIPTION i 1NORK:
DE�TA;ILED r �.. +r , • � • .a
0A )CY) QCCMa JUk Qu\(�o� c.1 W1X__-v1 0"r,1�
CO` STRUCTI,ON INFORMATION:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
XElectric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 11�S D Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: MIMC®NTRACI®R:
Name -SA(iitnnk, 61c 4 Y 0 Name:�C)r Q5 r��r
Address:2912 Ga4a„o1c Df ' Company: (,' 'iZCCN r--cG Com-'Ltle- (_CC
City:1/ [, State:f-L Address: ` 3 CJS
Zip Code:,I Y1 51Z. Fax: City: -Q)c� Stater
Phone No. 7 7 7 - 3y y J''?Y Zip Code:34 01%Z Fax:
r
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail�.pr
from the Owner listed above) State or County License 11,5JI J
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENT L C®NSTR;IJCTI®N LIEN LAIN bNF'OvRMTANITN;
DES 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:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
com nc g work or recording our Notice of Commencement
lvn, d4At�� rz N
Signature of Owner/Lessee/Agent cu=LLQ Signature of Contr ctor/License Holder C)
R
STATE OF FLORI STATE OF FLORID ��r
COUNTY OF - m � COUNTY OF 010
vo¢ P w.a
The f r ping inst ent was a knowled � t e The forgoing instr was acknowledged be 9�a
this�day of 20 y m this day of 20 �by � �b
(Name of ltson cknowled`ging/) (Name of person acknowledging) Q;;;i•J
Signature o otary Public-State of Flof' a) ignature of N ry Public-State of F rids ) ,
Personally Known/ OR Produced Identification Personally Known r OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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