HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
r RECEIVED AUG 2 8 2015
NNW 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:
PROPC?SE;D INPRQVlVIENT LCATIaN.
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Address: U �9 8, iirJ ell, ��T. 1�e� �
�� -- 5 L49 5 l
Legal Description:
Property Tax ID#: 130 -(QGS'0 O y Lot No.�
Site Plan Name: Block No.L
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESGRIPTIQN CF,WORK
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CONSTRUCTION INFORMATION a
itiona wor to a pe orme un er t is permit-c,ec a t at app y:
_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:$ LCJ�a�O Utilities: _Sewer _Septic Building Height:
"0 RILE ; : CONTRQR
AGT
Name V :.doe D68— Name: of fl ie-) 1)o�Cz'c/G
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Address: p z- ,zz�e,_'-d Company: 002!�;g,-k COV16a'v tCC 7611 L-L6
City: )5= Ae p State: FL Address: /7V/ �'LA) S- -
Zip Code: 3 1 Fax: City: PSL State:
Phone No. Zip Code: 1 U q Fax:
E-Mail: Phone No.. 6 92 '530- 2'('05
Fill in fee simple Title Holder on next page (if different E-Mail: VCf bed IS0L(4,
osy_4-
from the Owner listed above) State or County License: C&Ci
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
1
SUPPLEMENTAL CQNSTRl1CTIQN LIEN LAUV INFORMATIQIV.
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 Commencem
Signature ner/Agent/Lessee Signa o ontractor/License Holder
STATE OF LORIDA S TE OF LORIDA
COUNT OF C�C�C(P CO OF S� ( UC(Q,
TheAorgoing instryt�ent was cknowledged before me The forgoing instru nt was acknowledged before me
thi day of f 1(J V� 20�by. thio_day of 20 1':-Iby
TY) V-)�,6 1
(Name of p son acknowledging) (Name of pe son acknowled i )
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(Signatu f Notary Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Pr uced Identific tion
Type of Identification Produced TDrt✓(',-S L(CQ/)�— Type of Identification Produced_ �ri, yP�S C(CP�e.__
Commission No. Immission No. (Seal)
,RY P• NANCY HERRERA
�O1P fA�ii 11�11111/I�,i
_. •'�: Notar Public -state ,,.•1PRYP�o.�, NANCY HEARFRA
My Comm. Expires Oct 5.2)17
: ; c Notary Public-St to of Florida
REVIEWS FRONT ' : �G cQrrRSUfERYfl7ANS VEGE rf�EPire gbiA � E
COUNTE bonded hrou[tE�VIEVV4otaryIEW REVVViOFFIO; B 9Wion # F
DATE Assn.
RECEIVED
DATE
COMPLETED
—R—ev–.7/2014