HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:1 I�3I 15 Permit Number:
RECEIVED JUL 23 2015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 V
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: �1�- f ,e
Legal Description:
Property Tax ID#: 19 ay U - 109 6 C)d O 3 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 a qe orme under this permit-check a apply:
HVAC [:]G/as Tank ❑Gas Piping _Shutters Windows/Doors
DElectric D Plumbing Sprinklers 1:1Generator 0 Roof
Total Sq. Ft of Construction: S . of First Floor:
Cost of Construction:$ r1�( � Utilities:CnSewer Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name Zc- Name: Lt1' ::L_ t S
Address: ,1al a u 2 Company: 041
City: A D d OAJ_f State:f Address: S✓
Zip Code: Fax: City: i 1'p-V-C State:_
Phone No. Zip Code,31/2Y I?- Fax: p
E-Mail: Phone No. -,491 -
Fill
,o91 Fill in fee simple Title Bolder on next page(if different E-Mail: U x-64
I
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 LIE[ <LAW 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 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
commOcIng work or recogging your Notice of Commencement.
; a`-Zs
ignature of Co t
ner/ ssee/Agent Si ature of ra r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5k, COUNTY OF 61
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisQ. day of :S J�`b 20 6hy thisZ 3 day of �0 20.i.7 by
q { �r C r` �� �n►rV '�-e Ct S
(Name of per on acknowledging) (Name of person acknowledging)
(Signature of Notary Pu ' -State of Florida} (Signature of Notary Public-State of Florida}
Personally Known OR ��NfY �a i§lrftottda Personally Know ucWtl-I§hf S
Type of Identification Nc- 18. Type of Identificat n Mr d -..",Public..State o�- 13M6
,``RV1PUB��4�/ No Expa 8581 4 ��'= Expites '
Commission No. My Comme� a#EE otacy Assn. , - y Comm. E 858761
(T Y�Nat�onatN Commission No. �ommis�13� 1 pssn.
CidBonded Through Nab nal Notary
=;•,' ce.' gOnde canna••
Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
COMPLETE
INITIALS