HomeMy WebLinkAboutBuilding Permit Application ALLAPPLICABLE INFO MUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 27 SCf Permit Number: k150--a-3"
- RECEIVE®
Building Permit Application
Planning and DevelopmentServices SEP 2 2 2015
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:��Qo S �� �_f2�- 1
Legal Description:
Prope rtyTax ID#:0' f�0� ` .5_0 0,20 - 5Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: T Right Side:_ —Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work o 156 nertormed under this perms —check all thatappy:
I
❑HVAC Gas Tank as Piping Shutters Windows/Doors
Electric 0 Plumbing ❑Sprinklers ❑Generator ❑Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:_ _
Cost of Construction:$ —3r 940 Utilities: 0Sewer Deptic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameLZ /�� _T Name: G/r/�[=S Gdu/G
Address: 35=2 Clt`�/d1�S d2_,� Company:
City: 4!. _State:Alt7-- Address:
Zip Code:O 7 9 z V Fax: City: State.4L
Phone No. Zip Code:3 119 e z- Fax:
E-Mail: _ Phone No. (f77z 2^98--
Fill in fee simple Title Holder on next page(if different E-Mail: GLo (��21�JQ�r e o«7
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Add ress: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: ^ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Add ress: 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 Countymakes no representation that isgranting a permit will authorizethe permit holder to build the subject structure
which is in conflictwith any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibitsuch
structure. Please consult with your Home Owners Association and review your deed forany restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that 1 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 con currency revi ew: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 recording your Notice of Commencement.
s
—Signature of Owner/Lessee/Agent na ure of Contractor/License Holder
STATE OF FLORIDA'SSTATE OF FLORIDA
COUNTY OF � . �1 a COUNTY OF S - (tea-.lc I c
The forgoing instrWent was acknowledged before me The forgoing instrument was acknowledged before me
this 22 day of 1 ear 20 Eby this-2 day of �p�mbe�r 20 t 5 by
'&GA(ridA Fkevzs EVA
(Name of person acknowledging) (Name of person acknowledging)
L
( ignatu re of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known O ro ed n i i atto onallyKnown ��ropl�f4b �E14&i
Type of Identification Produc a4 o� ° Ile of Id entificatio i Evelinda Flores� My Commission FF 089788 c� My Commission F' IFF 089788
18
Commission No.FFa � morn (IR?"s02104/2018 mission No. F Expires 02! tea°
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS