HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q_
Date: L5 Permit Number:
RECEi'.„�D JUL 312015 *IA4
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 VIrglnla Avenue,Fort Pierce FL 34992
Phone:(772)462-1553 Fax:(772)462157$ Commercial Residential
PERMIT APPLICATION FOR: Electrical
TAddress: r i it
Legal Description:
Property Tax ID#: Lot No.— �—
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:__ Left Side:
Acicl
itiona wor of rrormed un ert "erm –t eta appy:
❑HVAC t_I 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:$ Utilities: Sewer❑Septic Building Height:
Name Name:
Address: I AdZRd Company:
City: State: Address•
Zip Code: Fax: City: State:
Phone No. 1q ttq00 Zip Code: Fax: L1075R9 I I
E-mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County license: ��,j-�� � I-0:1
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
010/90012 XVJ Lc:ZI 91.0Z/Lc/L0
5, 110
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Ad d ress
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 Count(makes no representation that Is granting a permit will authorize the permit holderto 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 5t.Lucie County Amendments.
The fallowing 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 wor our Notice of Commencement.
- \ - \ zgt��l� S
_Signature of Owner/Less gent Signature of Contractoe Holder
STATE OF FLORIDAC, STATE OF FLOR
COUNTY OF InIp. COUNTY OF
The oin instru e t wa acknowledged fore me The forgoing instrun easnt acknowled a efore me
this, day of 20 y this-- ay of 20 by
(Name&herson ackn ledgi (Name o per n a knowledging)
(Signatu o otary Public-State of Florida) (*n1wFe,,6f(*naryPublic- a of orida)
Personally Known 00"OR Produced Identification Personally Known OR Produce-d-Idgil
Type of Identification Produc pe of Identification Prod uc O`
;K lrim Commisslon#FF 175017
Commission No. 7�: .+. fission#FF 175017 _
�y ( s November 9,2018 mmission No. Ef�el�lpP�avemher e,2018
'q, r• ,• BvMaa thm TivyFdn lrtamime B00,985a 1B ,9;R7T"`` BVMvd'flw Troy Feln ln�wan'e"J67.7019
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
DATE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
COMPLETE
INITIALS
OLO/L00 O xvd Lc:n 4L0Z/LE/L0