HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
. R E C AUG 2 8 2015
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Building Permit Application
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: nC,e,
PROPOSED (NPR0VEMENT.LO_ CATION 1
Address: g90,5 yn eS R /e'ree l��
Legal Description:
Property Tax ID#: 1301 1 —&03 —0 d 25`- 000 [ Lot No. `ZS
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION
Additional work tobe pertormedd 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:$ 2000' D Utilities: —Sewer —Septic Building Height:
OWNER LESSEE CONTRACTOR:-
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Name GL' E;-1" Name;. e�°:� d
Address: 0 $ `C( mpany:
City:.. State:ELI Address: ��7� �� h otn
Zip Code:��v7 S Fax: City: PSL / State:_u
Phone No. ��® f�rJ Zip Code: 15WIL Fax:
E-Mail: Phone No. ?722 3O -S&0,5-
Fill in fee simple Title Holder on next page (if different E-Mail: c 7 nef
from the Owner listed above) State or County License: GAG OZ47(&6,6
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTRUCTIUN LIE. IN
LAINFQRMATIQW
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 thepermit 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
commen
,�Jng work or recording our Notice of Commencement.
Signatu caner/Agent/Lessee Signature ontractor/License Holder
STATE ORIDA STATE FLORIDA
COUNTY OF SA_ dc,-.e COUNTY OF S�-
The forgoinstrument was acknowledged before me The fing instryy,ment was acknowledged before me
this day of 20�by thisday of 20_6 by
(Name of person acknowledging) ( amN' a of person acknowledging)
� �_Onff) a Q'UJA' Q�� . "�" "
(Signature of Notary Public-State of Flo da) \ (Signature of Nota Public-State of Florida)
Personally Known OR Produced Identifica i Personally Known OR Prouced Id ntificationq
Type of Identification Produced �vt " P L►SA�tiDl I identification Produced L l
NOTARY PUBLIC
STATE OF FL I@�mmission No.EF��1Q/n/Ch a STATE OF FLORID
Commission No. Comm#FF0961 2
• Expires 2/25/2918 Comm#FF096192
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
-R—ev.7/2-014