HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE IN MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: L
RECEIVED
Building Permit Application AUG 2 5 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:
PROPOSED INPROUEMENT LOCATf ION:
Address: �� Sjee_r-- �//� Dar— a r- 7-L �i�►J
Legal Description: n43674 A R--t
Property Tax ID#: ej�JQ 2-- le 0-7- Q 1�6 —d ® 6`` Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:' Left Side:
DETAILED DE�SCR+IPTION QF WORK
1")6 C'.6 e 40
CONSTRUCTION I1N110RMATION:
Additional wor to be pertormed un er t is permit-Check a I that appy:
_Mechanical —Gas Tank _Gas Piping _Shutters _Windows/Doors
—Electric Z' Plumbing —Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First.Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWNER/LE=�SSEE: C®„N�RAC:T®.R;
Name /0 ems+ ►v. a_ Name:
Address: h6le _ c Njaer J,1 f)r Company:
City: 7` A'e f-,- e State: Address:
Zip Code: 31M 1�2 Fax: City: State:
Phone No. Le 3 Zip Code: Fax:
E-Mail: c?r v5RC0W 1 Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State'or County License,:
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
60 11
C®NS 15101mTION LIEN LAUD IN�®RIVIATlO`N:
/ — ApplicableMORTGAGE COMPANY: Not Applicable
DESIGNER ENGINEER: Not
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:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
commencing work or recording our Notice of Commencement.
'Sz�� 2U't'.'a !n irk
Signature of Owner/Lessee/ nt �a� Signature of Contractor/License Holder
� jy l.d o
STATE OF FLORI z`. ;
COUNTY OF ����� ' STATE OF FLORIDA
oma: COUNTY OF
min.:
The forgoLng instr rent was acknowledged b fw �� The forgoing instrument was acknowledged before me
this '�day of 20 y�}w this day of 20_ by
o
m
(Name of person acknowl ging)
Tib
(Name of person acknowledging)
l
(Signature ofP&fary Public- tate of F orida ) V (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of[den * cat'on a Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED HREY
DATE '`' i MY COMMISSION# F 174772
EXPIRES:March 6,2019
COMPLETED ., a
ev. aF„