HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I g 5 Permit Number: 15 d1 - O SJ
TD SEP 09`2015
RECEi''
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 X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ddf
PROPOSED IIUIPROVEMENT I:OCAT)ON -
Address: 8(ogo s Oc6pw� 7rL , -T�Xys r)
Legal Description:3N 13S� 3(o N 1 'f tf*r PA-(Zr of S o2�'i'1.(o(� Or% Iy 2 53S 8,9So F-r Dr
Z)
��� r' rJ L! a r-
00 S
Prope�Tax ID#: 3S -4— (11, O CX.YJ , Lot No.
Site Plan Name:� ��n/wt S t_ � IG, c ASSN Block No.
Project Name: i.{q�..� aN(;T &S rV C—
Setbacks Front N I�- Back: K4 Right Side: Left Side:
DETAILED DESCRIPTION'OF WORK
��fPG�wl 2 c>P(--pI�'1-S _? G+
01-E_C&4 600t 6vlk✓1.Y fluvsec- Kc)N 4^-(� .
CONSTRUCTION INFORMATIiaN
itional work tobene orme under this permit—c ec a appy:
HVAC L_J Gas Tank []Gas Piping _Shutters Windows/Doors
Electric ElPlumbingSprinklers I Generator 11 Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction: $ 9 `�'�'� Utilities: Sewer 0 Septic Building Height: /y
OWNER/LESSEE ,. " „s CONTRACTOR
: .
Name I S L h/ Name: cm 0y. N
Address: 0 Company: �&49/A10/4
City: l State: Fl— Address:
Zip Code: J'4Ct S:2::: Fax: City: CA/f171.1_ Stat :_�C_
Phone No. ( �a (7 3l Zip Code: N `1y Fax: (a J 2—f79"f
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: Ale, 142.r�7y`
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
if
SV LEfVIENTAL CONSTRUCTION LIEN LAW LAIN 'F
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 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 osted on the jobsite
before the first inspection. If yo tend to obtain financing, co It len r o n torney before
c m encin w or record'n our Notice of Commencem t.
s
_Signatu of Owner ess gent Signature of Contractor/ cense Holder
STATE OF FLORIDA STATE OF FLORI A
COUNTY OF S%40Cl,i5 COUNTY OF 5T 1_1_)C-11S
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of this S6eday of 20`�by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu lic-State of Florida) (Signatof�iJotary P lic-State of Florida)
Personally Known_ZOR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ,ti'Pr , ANN MOND Commission o''"�'y - ANNM.GAUMON Pa�)
MY COMM�11 FF 173907 COMMISSION 9 FF3907
M.••.. r;. EXPIRES:December 7,2018 =�,•., :a-' EXPIRES:December 7,2018
v •oP•`'
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
r