HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:-7/-& h115
Permit Number:
• RECEIVED JUL 08 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 arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:Q-5o A
Legal Description:pt" `r Ih 12 � J V v V 1(0 w�
Property Tax ID#: 14 (o 0 -DO L-1 'y �(�Y-)D � Lot No.
Site Plan Name:aso9 �W 4o llct L}�{raj c—�g Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
'CONSTRUCTION-IN FORMATION:
Additional work to be nertormed under tispermit—check all appy:
❑HVAC Gas Tank _ Windows/Doors
— ❑Gas Piping g Shutters ❑
Electric 0 Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: S .Ft.of First Floor:
�C
Cost of Construction:$5 � Utilities: _Sewer O Septic Building Height:
OWNER/LESSEE: CONTRACTOR`.
Name �U► -� �l Name: �1� EA
Address: ,So`27 NW LXJ Company: RM-trrtAyl
City State-f_ Address:ZZ U I &5-_ -x;g 1tth S 7
Zip Code: c34-7:3ib Fax: City: &AU /'+ State:��
Phone No. Zip Code: 3L-("71 -T Fax: 419 0S��D
E-Mail: Phone No. 7,q�3 cS(.o Ca
Fill in fee simple Title Holder on next page(if different E-Mail: firi " f;
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONMILICTION LIENLAW-INFORMATION`
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 accesso uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencem t may reCan
your paying twice for
impr ments to your roperty.A Notice of Commencement m e r corde posted on the jobsite
befor t first inspe ion. If you intend to obtain financing, coI i lenden attorney before
con work r recd,rdin our Notice of Commencem
c�vL_ s
_Signatu O ner Les a ent Sign re of ntr or icens H der
STATE STATE F F RI
COUNTY OF Lvc COUN �-f,
Theforgoing instrument was acknowledged before me The rgoing instrumentLas "nledged before me
this 4� day of 1 20 A5by this day of�s J�`R ,20 V5 by
(Name of person acknowledging) Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Pub -State of Florida)
Personal) Known OR Produ GIVENS FtOrrd y Known OR Produce GNENS
Personally of ersonall
Type of Identification Produ L bttc gt 20 D ���— torid
yp � pe of Identification Prod L State°
�� o Pay P„s�c,,,' Notar M.EXP ec 21
\.\v Pue"�, iresD
•.P� , N°D mm•EXP #EE 85 en. y 85876
Commission No. 5 _ ;. le rnrssip° trOnatNotary mission No. .tta%ll d k•'_l? ST isston#EE
a m � cY
•a`c ° h Nation NOt3
onded Shrou9
�,5• p�\.` ,E OFF
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS