HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (.O �- �'� ` �� Permit Number:
RECEIVED JUN'2 4 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 here S e,{'
PROPOSED.IMPROVEMENT LOCATION:
Address: S• V S Wy
Legal Description: Z (P 3
Property Tax ID#: 3 y rL" -c 1 - t c 1 y Lot No. 04 1�
Site Plan Name: Block No.3
Project Name: #04-
Setbacks Front Back: Right Side: Left Side:
DETAILED:DESCRIPTION'OF WORK:
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-CONSTRUCTION INFORMATION.
Additional wor to be oertormed under this permit-check all tha apply:
®HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
FlElectric Plumbing O Sprinklers F]Generator Roof
Total Sq. Ft of Construc ion: i S -7 S . Ft.of First Floor:
Cost of Construction:$ 2 1 ®O 0. 0 Utilities: l_J Sewer El Septic Building Height: 5
OWNER/LESSEE: cl o CONTRACTOR:
Name Fag
V,.V,a 1 tv C. ('s• dry MC1le- Name: J,91WW4 Z 204
Address: ;?n 3 -11 Z"Z Company: 314LC�
City:-F a✓} 51A. L kA,01 State: lrr Address: 14,1 S' ,��,/ ',9�/2d•f G�✓
Zip Code: 3�A 4 k S Fax: — City: S/- /Gc!'-� State: F/
Phone No. Zip Code: 3 y f'�Y Fax:
E-Mail: Phone No. '77 2 ZO i_991 9
Fill in fee simple Title Holder on next page(if different E-Mail: •,l�k.f 4 ,S'�7✓� (/l /f Q� (�/t'lY�G .C�
from the Owner listed _above) State or County License: 2�2-
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
commenging work or recording our Notice of Commencement.
Signa re of Owner/A nt/Lesse Si ture of Contractor/Licens of er
U I
`Sr ATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S . 1- > COUNTY OF %
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of IUYN J,� . 20 13 by this&Aday of ZV y\-- ,2016S by
2-
(Name
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public tate of Florida) 'tSignature of Notary Public-State of F orida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification-Produced L Type of Identification Pro u �-V
r GIVENS
DEANN F1o�� a „ „
Commission No. ' ,,,,, /�ccQ , Slate p116. ommission No. r P`';° lic-State of Florida
s oCaW bl'c pec 201 Noq
N mm EXplies 858161 My l;omm.Expires Dec 16,2016
_� •c MY Co lesion#EE lacy pss ;,q p Commission#EE 658761s n.'
6ondedthtou9 �'•,,,,���,,, on
Revised 07/15/2014
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