HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: 1 l Permit Number: 4514 - 031S_-
RECEIVED
Building Permit Application p1
Planning and Development Services JUN 18 .2015
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)46271553 Fax: (772)462-1578 Commercial Residential a/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: qGS % ars- U00 QrOe i Sk . LUC,1 3q q 1�u
Legal Description: WKe, ,k (DA N�M43- J z a 0 L Ui-
_.Cor 2S-0 - IUQO�
Property Tax ID#: J�J Lot No. 3
Site Plan Name: S�P;� y �\J�,� Block No.
T
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
j Qvau wmj �c4iun
CONSTRUCTION INFORMATION:
Additional work toa nertormed under this permit-check all appy:
[1HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
ElElectric Q Plumbing Sprinklers F�Generator Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction.$ UUP' I Utilities: Sewer Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name She.wg j-n(l l PName: _teQ Cn 01
Address: Goll 06 _(�I� C,IP Company:
City: LU o`Q State: Address: 310 "6J �n e S) P y-w
Zip Code: CAC u Fax:: City: W Q�t P G,M �jState: r �
Phone No. �� L' Lb� Zip Code: 03 Fax: 70 rt \Y
E-Mail: Phone No. CA V- 2�-2- Y
Fill in fee simple Title Holder on next page(if different E-Mail: D QY CY1 l j S C'(A�\ W C
from the Owner listed above) State or County License:_ F-C C-SIS51513
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
_Sig ur of Owne essee/Agent Sign re bf Con act r icense Holder
STATE OF FLORID ( n STATE OF FLORID r
COUNTY OF 4L1 1 I� COUNTY OF •i�U`c�(Vill, CJ C�'C. , \
The for .ng instrument vyas acknowledge efore me The f r instrument was acknowledged before me
this -d-ay of d 20by this day of 20 Lby
(Name of person acknowledgi (Name of person acknowled Ing)
,Z'Z
( ignature of Notary Public-State rida) (Signature of Notary Public-State of Florida)
Personally Known OR Produce qy)'f' tion— Personally Known NQR-P•r�o�duc`ed Identif'ca on
Type of Identification Produced � �/�/ / Type of Identification Produced
SI��V'4
Commission No. �N ( FLORIDA PUBLIC Commission No. tAy S N S.ADLER
,SF NOTARY PUBLIC
f F1 2169 —STATE J Q
c:xNjres i Comm#FF182169
Revised 07/15/2014 V/ 1O Expires 2/19/2019
REVIEWS -FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS