HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO M 5T BE COMPLETED FOR APPLICATION TO BE ACCEPTED r 1 r-�/J p
Date: �� Permit Number. (/ �`�'eo 0
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Building Permit Application AUG 3 1 .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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: " . � - ,
Address: ® �Affzl -e- ®.,—J ?4,>;< f,LC(e 3
Legal Description: (/� Q
� Sao c/):3 �-�"1� Lot No.
Property Tax ID#:
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
.DETAILED DESCRIPTION OF WORK;
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IVY Z_��ng'o
CO
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ION INFORMITION
Additional work toFeggertormed under tispermit—check all appy:
❑HVAC _Gas Tank ❑Gas Piping _Shutters a Windows/Doors
aEle tr ❑Plumbing Sprinklers Generator _ oof
Total Sq.'Ffof Construction: / '!C14A .Ft.of First Floor.
Cost of Construction:$ Utilities: Sewer ElSeptic Building Height:
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OWNER/LESSEE -'CONTRACTOR f 2
Name S '>P Name: % C
Address: s Company:
City: State:_ Address: -
Zip Code: Fax: City: State:
Phone No. `r7 33('D Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
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:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Counter 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 math 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 ofording your No "ce of Commencement.
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Signature of er/Agent/Less Signature of�ntractor/License r
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF ,t�_J
1� COUNTY OF
The forgo'ng rostrum t was acknowledged be ore me The 7-Xig�l
nstrume t was acknowledged before me
this Vday of 20 1 by this of 20_y
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(Name rson ackno dging) (Name of p s n acknowledging
0Z 14k,
(Signature CANot • uc-S to of Florida) (Signa u e f No P i tate of Florida)
Personally Known tl/OR Produced Identification Personally Known OR Produced,Identification
Type of Identification Produced Type of Identification Produced
Commission No. (eau FRAMPTON Commission No. �+A�
MYCOMNISSION#FF188186 ROY FRAMPTON
MY COMMISSION#FF188186
WIRES: MU"K 20151
Revised 07/15/2014 -
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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