HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number:
RECEI�'-D jUL.24 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: CAS SgA Ll) c-AJ
Legal Description: 012n 556Ar Q ��j&j4�b 11A [l' �WO 4O7' 72� ot` 6`1- ?Z�,/l
Property Tax ID#: 1339 '5v2' C>](.26- COD C Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
'.i ft4C SIM0 �it SSM S_f0.J YL /'-'o S,�
PNCC. 1��GL.) lac of SSS-`
CONSTRUCTION INFORMATION:
=/ HVAC
workto e e orme under t —checkispermit a appy:
Gas Tank F_]Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ J�U Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: I�IC�IAP,J ��<1C�1J
Address: v5v24J ( Company: COL4 V__k�mczh f ,¢ C WC
City: Ipt R.I .I. State: PL• Address: r'.3-3 N/k t4; ( v,j 4,il
Zip Code: 4!�(:U 1 U Fax: City: '?')R,T-SS CvCIL Stater .
Phone No. F3L41 -3`jb 320,E Zip Code: U 9P Fax:
E-Mail: _-f+f k 4EA6A( 0 Aut CUM Phone No. M9, 121VY
Fill in fee simple Title Holder on next page(if different E-Mail: f, VV4-J S C (') ✓pCd.5r_ lV T
from the Owner listed above) State or County License: ehe�o^i ?!S--
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 thepermit 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 Commencement.
_Signature of wner/ essee/Agent Sign re ra or/Li nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF "QCOUNTYOF 6-� . Loci 'P,
The forgoing instrument was acknowledged efore me The forgoing instrument was acknowledged before me
thisayl day of 7SO k�I 20 5by this Widay of 20 0 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu lic-State of Florida) (Signature of Notary Pu c-State of Florida)
Personally Known OR Produced 1 .as Personally Known OR ProducedIdent_i_fi�
Type of Identification.Produced aNP �e°to�e Type of Identification Produced ® s
- - Q�b\�c' es�eC 16� DEpN tatie°t Flo
Commission No. r „'' , N°�a� l�xpo#EE85oatY PS5°' Commission No. �o o1atY P°b�iSl�ec 16.6p16
-��` Q_My c°mm`s U9hNai�o°a�N 2~.'�'«� MH c0nn
mm�s ion#Ea�yo aY Assn,
s goo s • e S ed thtou
Revised 07/15/2014 i; FF, ,, `o; 6o°d
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
COMPLETE
INITIALS