HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED . t
Date: �1T l�J Permit Number:
MU
RECEIVED JUM 2 5 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: ckL
PROPOSED INIPROVEIVIENT LOCATION
Address: ?0S-
Legal Description:."�JIw,�7,0 4"(;r21' 0 0-- ,4
Property Tax ID#:3 (�� �(`p/C� -(',� / -coG Lot`No. �a
Site Plan Name: Block No.. E)
Project Name:
Setbacks Front Back: Right Side: Left Side:
RIPTION.OF WORK.
DETAILED DESC
S�J�_
7.S_ t,(I--cd 1�e4
CONSTRUCTION INFORMATION
L.. . r
Additionalworko e pe rorme under this permit-check aTFt at'apply:
V HVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction-$ 34,60 60 Utilities: —Sewer Septic. Building Height: .
OWNER/LESSEE CONTRi4CTOR
�- Name )D,SP . -... . , .
Name . �L ('A 21L
Address: , 70 E4PA!✓tA 4, Company: SL OC-,'e ,y��f:.f .�' 19/C lir_
City: )nf i,eip(e State: F11- Address: Col/�
Zip Code: Fax: City: &&-ce State: %I
Phone No. Zip Code: Fax:72,9- Y(od "5�&9I&
E-Mail: Phone No. ?�9, C/6 2-- 3c2do
Fil.I in fee simple Title.Holder on next page(if different E-Mail: .Sl/uG�le
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAVH INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: ---Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE BOLDER: --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 your Notice of Commencement.
6)sgnature of Owner/ L Lessee/ e( i atLu7rre of Contractor/License Holder
STATE OF FLOR A �� STATE OF FLORIDA ]
COUNTY OF - L—uc i C- COUNTY OF S` k Li C,
The for oing instru,w1ent was acknowledged before me The forgoing instru ent was acknowledged before me
this day of_ U Lxr\e- 20 15 by this�6 day of iJ,r�t� _,20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signa re of NotaryPublic-State of Florida) (Sign ture of Notary Public- tate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific " Type of Identification Produced
Awl ;e JENNIFER A FUSCO
Commission No. = Mr COMMISSI&AE122497 Commissio JENNIFER A FUMO)
EXPIRES October 23,2015 °= My COMMISSION#EE122497
°'Al
EXPIRES
(407)39&0153 FWdalloWryservice.com
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA-TURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS