HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: • �J� • Permit Number:
Building Permit ApplicatioPECEIVEle
Planning and Development Services
Building and Code Regulation Division- AUG 7 2015 .
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: �1e �- a�JC
PRtOPDSED NPRaUEMENT LOCATIdN:
Address: /s 3� �� 1T -0-rc to �y Y7
Legal Description: Vii✓1 r?"Oad
Property Tax ID#: �? 69,7, Oe -� DOd Lot No.
Site Plan Name: Welp CS Block No.
Project Name: a avoch
Setbacks Front Back: Right Side: Left Side:
DETAILEcD [ E:8 RIiPT1®.N
CONSTRUCTY®N INFORMRANTI _.
itiona wor to be performed under this permit-check all that app yi,�-,
Mechanical =Gas Tank _Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprinklers Generator _Roof
Total Sq, Ft of Construction: CC Sq. Ft.of First Floor:
Cost of Construction:$ -SJ� Utilities: —Sewer —Septic Building Height:
NallIC - is 4(4, ame: L.
Address: Company: ate?
City: ftp /��e
y �`( State: /G Address: P-O, l�o�o kJO R`/
Zip Code: _�YFax: City: yL"o Rel'cd State: /"
Phone No. 72 PJPa -021?- Zip Code: 31 V_.s' Fax:
E-Mail: Phone No (2;0 ,50 `20-lv
Fill in fee simple Title Holder on next page (if different E-Mail ReAd:1'o9 I e, 0��C^ Cal
from the Owner listed above) State or County Licen,g
Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONST'R.UCTION LIEN LAW L,N ®RMAT(ON:
10
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:
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 re ding your Notice of Commencement.
P-.e,
Signature of Owner/Lesseejl g nt s "4.;. z :'Signature-of-Contractor/ icense Holder ""'- '•'''
STATE OF FLORI55L-
The
Ys; . STATE OF FL I - Xg
18
COUNTY OF COUNTY OF 2�M=
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forgging instru nt was acknowledged be rg®@ o The fopgoing instru nt was acknowledged befor im(g Z
this " day of 20 b o� this�day of 20 1SIy =
C OST Liz
(Name of person acknowledging) „� (Name of person acknowledging)
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Signature of N ryPublic-State of FI da ) (Signature of N y Public-State of Florida
Personally KnqWq OR Produced Identification Personally Known OR Produced Identification d�
Type of Identi ca ' n n Type of Id 'f a.,ions
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION S_EATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE -
RECEIVED
DATE
COMPLETED
ev.