HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ?
Date: Permit Number: SoQ •0Y
a h RECEM`D SEP 0 9"2015
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: To Select from dropbox, click arrow at the end of line
T ;
PRQPOSED 1N1PR�1lEMLNT LO"CATIUI „ y
Address: 1 1 000 S Qcao,) DtZ - -G � �E1`1S£-►J '(&-A , �l
Legal Description: 41L-LA CL Scat_ UN1-r il"i"O VASO
( #N Cn A4 M cta -> r;r bt2 1 OT6 —(c�
Property Tax ID#: JqSl 2 - ?O l —00Y(o- coo -O Lot No.
Site Plan Name: O#Q Block No.
Project Name:
Setbacks Front N Back: N(�Right Sider_ l _Left Side:
D"ETAILED DESCRIPTION OF WORK
n-1- 6x I s rrIA4
k ➢t Y }L
CC}NSTRUCT[ON INIF RMATION
Adriffional work to e e orme un er this permit-Check a appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric ❑ Plumbing []Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ �(tD�� Utilities:cnSewer❑Septic Building Height: 1
OWNER/LESSEE y
CONTRACTOR
Name Name: �Gl
Address: Company: -vJai=-P1
City: F State: Address: 172c, NW �A
Zip Code: SKS Fax: City: Sfv/2-�r State.,—
Phone No. 1 9$ - u Zip Code: qDe Fax: 2-
E-Mail: Phone No. (A q Z - /130',7
VV
Fill in fee simple Title Holder on next page(if different E-Mail: l/ G ..
from the Owner listed above) State or County License: /��' n o, ? --�
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SIJPPLENtENTAL CONSTRl1CTIaN LIEN LAWINFC}RMATI�N '
' e. b •ar-
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 thepermit 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 ilure o Record a Notice of Commencement may result in your paying twice for
improvements to your pro /y,
otice of Commencement must be recor d a id posted on the jobsite
before the first inspe o Ifntend to obtain financing, consult wit I attorney before
co me ork r rdour Notice of Commence
CL
s
_Sig re of Owner/ a Agent Signature of Contra r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF�5/ COUNTY OF 57-
The
'7The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi5:0day of� �s�ll3�2, 20/.5 by thisc�day o20,6 by
(Name of person acknowledging)� (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signatu f-NotaryPublic-State of Florida)
Personally Known ✓ OR Produced Identification Personally Known I OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. •.••'�""'f�'••. ANN OND Commission No. +a�'"''y.`''•. AN OND
1Y CONN SSIv FF 173907 _.. MY COMMI5S I FF 173907
a EXPIRES:December 7,2018 ; A EXPIRES:December 7,2018
'' "tee Bonded Thru Notary Public Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS