HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC L-E�IIN�FO)MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED rn J r
Date: YC u_ / S_ Permit Number:
Building Permit Application RECEIVED
Planning and Development Services AUG 2 8 1015
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: To Select from dropbox, click arrow at the end of line
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PRO,P.OSED IMPROVEMENT LOCATION.. ..
Address: % 0
Legal Description: PO✓' ` r — ���� f+.✓ - < L
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Property Tax ID#: 50 -,7--io 0 Lot No. Y G
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED'DESCRIPTION OF 1NORK
GI (Py7 G�a�a�� �om�' Li e o L ke
CONSTRUCTION• INfORMATIO'N.
Additional work toe e orme under this permit—check a appy:
HVAC []Gas Tank as Piping [lenerator
Shutters windows/DoorsDElectric 1:1Plumbing Sprinklers 0 Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ �. �• UtilitieslnSewer OSeptic Building Height:
OWNYER/LESSEE CONTRACTOR:
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Name ;n Name: n% L
Address:S7Y0 Cin iSh i Company: I it- 0 i o !S
City: 4 CC State:2`L- Address: i)moi✓� ,�1/�
Zip Code: 3`?rte 1 Fax: City:Phr4 _S4. bAc I e State:—&
Phone No4:z7�1 9 7/ - a 693 Zip Code: 3y063 Fax:
E-Mail: /111A Phone No. .3 7V 8
Fill in fee simple Title Holder on next page(if different E-Mail: f' flf7• LDrb'>
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEM`ENTA'L CONSTRUCTION LIEN LAIN INFORyMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City' City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.LucieCounty makes no representation tliat 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.
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Si tune o Owner Lessee �� "No•• Signa re of Contractor/License de TLt'"' zN
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STATE OF FL D �i ;rt; STATE OF FL A
COUNTY OF COUNTY OF
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The for ng instr nt was acknowledged t1 The forgoing instru nt was acknowledged b @reX@q3
this day of 2(}� min this��day of 20 J
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Twos v �zc
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(Name of person acknowledging) ion (Name of person acknowledging) N-
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(Signature otary Public-State o Florida (Signature of Nota Public-State off(rid ) 61
Personally Known OR d ced Ide ification Personally Known O d ced Id �tificati
Type of Identification Produce WI Type of Identification Produce - �-
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS