HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��//�
Date: • Permit Number: ��i'
Building Permit Application RECEIVED
Planning and Development Services JUN 2 5 2015
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
PROPOSED IMPROVEMENT LOCATION:
Address: 3I 00 LI f
Legal Description: `pOH 02 ru 4 ��QV� ` V'1Lgi I
COUSS
Property Tax ID#: �� 707 - 001 +000' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF,WORK:
I =► '� V-ky-e
CONSTRUCTION INFORMATION:
Additional work to be nartormed under this permit-c ec a app y:
HVAC � Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ® Plumbing Sprinklers 0 Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �� Utilities: Sewer 1:1Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name T)nu i V-\ Name: 1�0�
Addres S OO -IY�'C S w� �r� Company: C
City:�� 'SA Klo a State: f-L Address: qW W A'
Zip Code: 31 f V; Fax: City: U.. S / e State:
Phone No. 77,L #(o - 2972 Zip Coder b Fax:
E-Mail: Phone No. - M—CORD
Fill in fee simple Title Holder on next page(if different E-Mail: ' l 00
from the Owner listed above) State or County License: C �q�Q Ogg
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION-
DESIGN ER/ENGI NEER:
NFORMATION:DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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
commencugi,work or recording our Notice of Commencement.
S
_
Signaturl of Owner/Lesse gent Signature of Contra r/License Holder
STATE OF FLORIDA _ , STATE OF FLORIDA
COUNTY OF �J" c.Gc Q COUNTY OF S�iC C�Lc G
The forgo' g instr ent was acknowledged before me The forgoii g instru nt was acknowledged before me
this 9 flay of 20 &by this TTy of 20 _s'by
CfYt �j' G/h�
C-7 P1 glial/
ame of p o le ing ame of person acknowledging)
(Signatu of Notary Pu c-State of Florida) (Signature of otary Publ' State of Florida)
Personally Known OR Pro uced IdentificatioPersonally Known OR Produaecl Identification
Type of Ide ` Type of Id
,, NANCY E.FAJANS ,, NANCY E.FAJAN$_
Commissio ke °e [a,State6PAd;iba Commissi no, b am State offUdP l)
Commission#FF 123596 Commission#FF 123596
t
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS