HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t�
Date: 1�a�!�5 Permit Number: S�1-d3 l3
-- -- -- --- ---- RECER'7D JUL 23 2015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 trrginia Avenue,Fort Pierce FL 34982 L�
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line umb j h
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: ��'� ��� �o 'Z�C3 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:
AdClitional work to be Derrormed under this permit–c ec aflt appy:
HVAC ��Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric I-Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ f��� Utilities: Sewer OSeptic Building Height:
OW N ERAESSEE: CONTRACTOR:
Name 7 Name: [roksz� �erT'I
Address: Company:
City: stater Address:
i
Zip Code: Fax: City:_ T-�- State:_L
Phone No. Zip Code: Fax:
E-Mail: Phone No. 7 7 a-
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: JDA4
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 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
commen,cingwork or recording our Notice of Commencement
. '(Z-1-1 � - (1�11 61��� s
_Signature of Own r/Lessee/Agent Sy ature of ont actor/License Holder
STATE OF FLORID STATE OF FLORIDA,, -
COUNTY OF COUNTY OF c
The for oing instr en was acknowledged before me The for oing instrument was acknowledged b fore me
thiso7 day of 20 L this! day of 20 by
e of p r on acknowledging) N me erson acknowledging)�
1 �
Signature of Notary Publi tate of Florida) (Signature of NotaryPubli -State of Florida)
Personally Known --%014212; ac idiatiLfiratic n Personally Known _WAS i ti
Type of Identification'Pr DAWN MILONE Type of Identification PID dt 'p"'�, .
s
'10 � iNotary Public-State of Florida. _�• �`�: Notary Public-State of Florida.
Commission No. i My.Com"irei Mar 22,-2017 Commission No. h ���?My CG"afikbires Mar 22,2017
•s�rF � �- Commission EE 8.77571 '" :91F `o �,�. Commission EE 877571
' � Bonded Thr h National Bonded Through National Notary ASSO
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
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