HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - o77- Permit Number:
RECEIVED
_ Building Permit Application AUG 27 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:
PRQI'OSEDLNPROUEMENT LOCATIfJN:
Address: -7 q��0k_
Legal Description: W4
Property Tax ID#: 2-�o'7 (Z( 0025 0006 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA LED Df�S�R+IPTION 0 1NORK:
CQN+STRl1CTI0N INFORMATION:
Additionarl work to be pertormed under this permit-check all that appy:
Mechanical _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:$ t2i 'T-Cv� Utilities: —Sewer-, _Septic Building Height:
OW NEER/LE�S�SEE CONTRACT®R:
Name ✓ZA Name: L4oi
Addressr d}' D'� C N CT Company: BSP— 4 �
9-1V -�r�! 6ax?
City: �roa ►2 State: r'G Address: E36 tga�'- (E
Zip Code: Fax:-Fax: City: I'S L' State:-E-<-
Phone No. Zip Code: Sco Fax(
E-Mail: Phone NoSq� �
Fill in fee simple Title Holder on next page(if different E-Mail L-VOK AP-Q 55 F- Goy
from the Owner listed above) State or County Licensees e- t l al
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S PPLEMENTAL CONSTR CTION LIIEN LAW I� FORMA►1'(ON:
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 recording our Notice of Commencement.
Signatur of OwnLessee/Agent Signatur of Co ractor/License Holder
STATE OF FLOR A STATE F FLORIDA
COUNTY OF NT 1A01 E OF dlldI47 210L
The for ing instr ent was acknowledged before me The for ing instr ent was acknowledged before me
this ay of M"T ,20J,5�by this2pdayof 20L,5 by
A
(Name of person acknowledging) �' °'° (Name of person acknowledging)
M
(S na re of Notary lic-State of Florida ) o cn N m (Sig toe of Notary P ic-State of Florida ) m 2 n .
Personally Known W� OR Produced Identif 44OX Personally Known OR Produced Identificof o
Type of Identification m rn Type of Identification a cm
Produced °D m 'i
Produced c o N m X
CD
Commission No. LEIj71MU (Seal) [C—n Commission No. al7-7 IU (Seal) °' �
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. -