HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LEI FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /n l
Date: Permit Number:�J
5 -
RECEIVED
Building Permit Application
Planning and Development Services AUG 10 2015
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: E
CI 449SZ
Le al Description: I� CC '� Ud
A
�-A, Pe) 3 a . 3 Col o�
Property Tax ID#: 54a-A o",�L-a 169 - 0QQ -- 8 Lot No. IS
Site Plan Name: Block No. W
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAII.E'D DESCRIPTION OF.WGRK:
(1 CH A Gi F OU T
w
�TR `CrT f �1AT#�N:
Ad�ditiooal work toe e orme un er t is permit—c ec a appy:
L_:.IHVAC 11 Gas Tank DGas Piping _Shutters a Windows/Doors
11 Electric El Plumbing Sprinklers ElGenerator Roof
Total Sq. Ft of Construction: / S Ft.of First Floor:
Cost of Construction:$ ji��`o'`' � Utilities: Sewer E Septic Building Height:
OWNERKEWE: CONTRACTOR:
Name 'l1��lial/j/ yl _ ame: TE Y)
2 A� s ivef� AI'5 ,,-) ompany: L T05%
Address: .� �,
City.; E: 451Jr 64E.0/e State:_L Address: VQ D
Zip Code: '� - Fax: �} city�of2-T _)T L1.1 C 1(= State:�C
I — Zip Fax:
Phone No.� � 3 3 � Zi Code: 9�
E-Mail:_ Phone No. ) '— �� �J~� C:)
Fill in fee simple Title Holder on next page(if different E-Mail: 01 co(n
from the Owner listed above) State or County License: Cjarlks,14EM
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: —Not Applica
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: hone:
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
commencin work or,recording our Notice of Commencement.
s
Ae
_Signature of ner/Lessee/Agent Signature of Cont r or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S`T LL4 +E COUNTY OF Luc 1E
The f oing instr a_ent was cnowledge re me Thegfing inst ent was know ledged before me
this day of 20 by thiay of 20 by
CHERYL A.FINK CHERVIL A.FINK
(Name of person ac I �')My Comm.Expires Mar 28,2018 a(Nja"efson acknow Cpa,E*m Mat 26,201Co ission M FF 1046FF 104667
/A
.g 8ture�f ary Pu` is-State of Flo a) to�ZR
State of Florida?ersonally Known 0R Produced Identification Personally Known Produced Ideptiftcation
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. � (SeA
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS