HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' I 1• J Permit Number: z:QV
RECEIVED
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Building Permit Application AUG 11 2015
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: h fi �. -> . S
Legal Description: ?
Q G 3 Y 3 9 Th,- 474v+ 5s hcwn La a K 2-306-173
Property Tax ID#: 13 66-SC —16q / —0 cra—7 Lot No.=�1
Site Plan Name: L Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK � - _ _ __ {.�,
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CONSTRUCTION INFORMATION ;
Additional work to e e orme under this permit—check a app y:
HVAC E]Gas Tank E]Gas Piping _Shutters Windows/Doors
Electric 1:1 Plumbing Sprinklers 1:1 Generator E]Roof
Total Sq.Ft of Construction: -/ S .Ft.of First Floor:
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Cost of Construction:$ r3 d Utilities: _Sewer Septic Building Height:
OWNER%LESSEE CONTRACTOR
Name Name: K. - C
Address: c Company: / r e rw vL-
City: c= L State:_ Address: 4 C 9 3 F f—
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Zip Code: 3 n—( Fax: City: Ffi f zvc� State:
Phone No. 3 Zip Code:3 Le 67>" Fax: 7 -2 ;1-—
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: K C ce l CLPe,oal
from the Owner listed above) State or Coun License:
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 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
commmcing work or recording our Notice of Commencement.
s
ignature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLO
COUNTY OF COUNTY OF
The fQ oing inst ant was ac mowledged_lefore me The forgoing instru was acknowledged before me
this i I day of 204 by this day of 20/J_ by
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of 66tary Public-State of Florida Vg (Signature of lUtary Public-State of Flori a) To.
Personally Known OR Produced Identificati 99 :_,3 v— Personally Known �OR Produced Identificati �C5 °
Type of Identification Produced `9' Type of Identification Produced
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Commission No. (Seal) Lp $ Commission No. (Seal) 4 Do 0
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Revised 07/15/2014
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