HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
'
Building Permit Application RECEIVED
Planning and Development Services JUL 1 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: ly (2 1-1 W S C)CaA) O 2
Description:Legal
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Property Tax ID#: 00 C-I OCU O 0001 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
�Additional work to be nertormed under tispermit-check all appy:
L 1HVAC Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �SDy Utilities:0Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name StC,4IJ IA)03 Name: fgf G M M _ QZ kA,2r
Address: /0 0-I4 S OCC-rIIJ c72 Company: COLA We
City: 2C14- State:PL Address: 1,_3 3 I-Iv2 t Zv.v e_ /
Zip Code: ��'t,96 9 Fax: City: !R0 P-!r SS GcXIi_ State:
Phone No. '/1�,,J. 4100 1?673 0 Zip Code: Sg0t ib S Fax:
E-Mail: Phone No. 99A Ir'j'`I ib A'175`f
Fill in fee simple Title Holder on next page(if different E-Mail: V U(_lC�' e Ca J4 CA 5 7- 7
from the Owner listed above) State or County License: (P/fCyl-l�it Z 6
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 Comm encemfe .
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_S ure Owner/Lessee/Agent Sig ure o tractor/License Holder
in STATE OFF ORIDA ?LL STATE OF FLORID �N
COUNTY OF �"�a COUNTY OF. 01
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The forgoing ins nt`was acknowledged be f Q 2 The forgoing inst n was acknowledged befCC m�w
this day 20 bye this day of 20��b �0-15
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(Name of person acknowledging) • (Name of person acknowledging)
ignature of ryPublic-State of Flor da) Signature of o ry Public-State of Flonda)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS