HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETEE FOR APPLICATION TO BE ACCEPTED
Date: �5 Permit Number: 9-
RECEIVED RECEIVE®
ve .;RENEW Buil. ing Permit Application SEP 2 2 2015
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-157 Commercial Residential
PERMIT APPLICATION FOR: To Sel t from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATl N:.
Address: 39 ,6_1
Legal Description:
Property Tax ID#: 02 Y o Sr - 14 o 0.3/v_ coo-IF Lot No. 42W
Site Plan Name: Block No. 7
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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,mss V--W/ A'.Pew
CONSTRUCTION INFORMATION:
Additional work to be errormed un er i permit-checka appy_
11HVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers 1J Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities-U Sewer Eheptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name .[ L p4vwo7 Name: `5rsP�h Yu1 V
Address: I'to $ l^I
-d-rd e Company: ADCIs ItJrnbiy�tCS'-Irnc..
City: Orf- P et`Ce State: ICs- Address: IgOa 59 Bvlfio PWe-
Zip Code: 3 K S'? 7 Fax: City: art 6r, t_uictc State: 11-
Phone No. '7 'U Bob .03 fg Zip Code: •y4952` Fax:7?1_-335'ab90
E-Mail: TeA.•ss&n. / e C.&-_e ^sv: vte- Phone No.171-3�?--36SZ
Fill in fee simple Title Holder on next page different E-Mail: C�enesss`{�l+�r�bnl�[PG f�1 d�n
from the Owner listed above] State or County License:C LA lot i +5
If value of construction is$2500 or more,a RECC 11 DED Notice of Commencement is required.
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SUPPLEMENTALC.ONSTRUCTION LI
LAW.-INORMATfON:
j DESIGNER/ENGINEER: ^ Not AMORTGAGE COMPANY: Not Applicable
Name- Name:
Address: Address:
City: City: State:
Zip: Phone: Zip: Phone:
! FEE SIMPLE TITLEHOLDER: _NotA licable BONDING COMPANY: Not Applicable
Name: dame:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation hascommenied prior to the issuance of a permit.
St.Lucie County makes no representation that is I ranting a permit will authorize the permit holder to build the subject structure '
which is in conflict with any applicable Home Owv rs Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners sociation and review your deed for any restrictions which may apply.
In consideration of the granting of this requested iermit,l do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florid Building Codes and St.Lucie County Amendments.
The following building permit applications are exe i npt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wa Is,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Rerd a Notice of Commencement may result in your paying twice for
improvements to your property.A Notic' f Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend a obtain financing,consult with lender or an attorney before
commencingwork or recordingour Noti e of Commencement.
s
_Signature of Owner/Lessee/Age gnature of Contract r/License Holder
STATE OF FLORIDA. STATE OF FLORIDA
COUNTY OF S'�- t:,,a;' COUNTY OF _V
The forgoing instrumentwas acknowledged befo me The forgoing instrument was acknowledged before me
thissday of .1VIA�—Ar.- , 20 �Sby: this 0 day of SP1',4.,0-- 20 l by
(Name son cic gi (Name er n ac ing=3
-
C
f
Sig wgss of Florida) ), :.
Personally Known OR Produced Identifi tion Personally Known OR Produced Identification
Type 'Produced i yp ton Produced
Commission No. (Seal) Commission No. (Seal)
Revised 47/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE j
COMPLETE I
INITIALS
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