HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACC EPTED r
Date: Q' (D Perrr it Number: ���• y / 9�
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Building Permit Applic 3tion SEP 11 .2p15
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34952
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: qT10 &<0QK6D Z7
Legal Description: Pow(w V E. 8 —d
G 3 O _3270 -ZIZZ u
Pro pertyTax ID#: 049•Q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Lefi Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work toe e orme un ert ispermit-c ec a appy:
HVAC 11 Gas Tank ❑Gas Piping, _Shutte rs Windows/Doors
Electric .Plumbing Sprinklers FIGener for E] Roof
Total Sq. Ft of Construction: Sq. Ft.of FirstFloor:
Cost of Construction:$ �S� Utilities: Sewer I I Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Ao r-, f, 1 2)6 �.an-eV Name: TU I IV
Address: 15 .ova. V'ih[-, Company:
city:5GJklrtywrnaLAN% State:±'A(N Address: q SEU-tdn Ave,
Zip Code: 0266 L( Fax: City: ?brt-St.L-Jelt State: AFL.
Phone No. Zip Code: 3 5 Fax:77?2.33S-DLO 0
E-Mail: Phone No. 7-3(-2
Fill in fee simple Title Holder on next page(if different E-Mail: �INr�b �ecd�ceS M Orh
from the Owner listed above) State or Cou n ty License: C x-12 b
If value of construction is$2500 or more,a RECORDED Notice of Commencemeni is required.
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SU.P.PLEMENTAL CGNSTRUCT1ON'LIEN LAW.INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGECOMPANY: _Not Applicable
Name: Name:
Address: Address: j
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING CC MPANY: _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 per it.
St.Lucie County makes no representation that is granting a permit will authorize th ermit holder to build the subject structure
which is in conflict with any applicable Home owners Association rules,bylaws or ai id.covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your dee for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I w ll, in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie Cou my Amendments.
The following building permit applications are exempt from undergoing a full concu rrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and acces.,ory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commenceme it 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
commencin work or recording our Notice of Commencement.
s
_ ignature of Owne essee/Agent
-Signature of Con tractor/L'
STATE OF FLORIDA, STATE OF FL RI DA
COUNTY OF S�- Z,e '-eCOUNTY OF S� -c
The forgoing instrument was acknowledged before me The forgoing insl rument was acknowledged before me
this_/,o day of_ 1 /;�w4 20 :Cby this l0 day of 20 !S by
(Name son ck gi (Name er ac ing
AT i ICK
C 3
Sig a of onda) ' ary
as erMca.mR F SwMa
Persona{ly Known OA Produced Identification Personally Kno n, OR Produced Identification
Type Produced ype Ion Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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