HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:7/d r//S Permit Number: 0�td
=.. "' ��
�~�+` RECEIVED JUL 2 72015''
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:
PROPOSED IMPROVEMENT LOCATION: .
Address: f91e161S 315
Legal Description:
Property Tax ID#: ,3y/0 p S03- O//L/ -a0y L/ Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIP,TION'.OF WORK
(9 e,°.•S �'�c, S�,7^s ?•J /�i� �� J sy s fes t v� e j-a v f e -2
Syr
W,41 -F /lk,,;i
CONSTRtJCTION,I:N;FORMATION
Additional work to be performed under this permit—check all that appy:
----HVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.,of First Floor:
Cost of Construction:$ _ y Gi!I Utilities: _Sewer _Septic Building Height:
OWNER%LESSEE _. CO'NTRACTOR
Name Name: SehL+. C�
Address:" Company:ST- A/c-
City:� `��� State;/r� Address: `//3 cf�SS�'`r �J�•
Zip Code: Fax: City: erz C, State:
Phone No. 110f" d Zip Code: 3 y5fFax: 72
E-Mail: Phone No. 7,,2, yb 2- 3a,10
Fill in fee simple Title Holder on next page(if different E-Mail: 5Zk6le- 4.,- 6 h el) Sova�.- ;-,e7-
from
e%from the Owner listed above) State or County License: LAG 1jr-1 5/ 7S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL-CONSTRUCTION LIrN: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: ZlNot 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 anyapplicable 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 Commencemen .
cam— dC�ti / s
nature of Owner/Lessee/Agent Si ure of Contractor/License Holder
ATE OF FLORIDA ATE OF FLORInik
COUNTY OF 15k, I-QC 1Q' COUNTY OF �,1-.0 C\
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thiel day of 1J 20 �5 by this a1 day of 1-0`f 20 %5 by
7S ase !D h C 4 c r 7?)se.P, b. cc, f r,
(Name of person acknowledging) (Name of pe on acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Notary Pub' -State of Florida)
NP GIVEN o`F�oi�0,�6
Personally Known OR Ped) ntifrLMigro5.2 Personally Known OR Produced Identi
Type of Identification Pro ` - aes 596 n• Type of Identification Produced P G� F�oc1
Pus2.
, My G°mm�ss�0 Na��o°a�No�a
Commission No. co �(�kh Commission No. ue Nola a� pace a5g76�
'r 9oode� fi� '2 'y MY c°°` �s °Na�oaa�Nolaty Asso•
Revised 07/15/2014 """UF'""
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW. REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS