HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application RECEIVE®
Planning and Development Services c
Building and Code Regulation Division SEP 12015
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential F _Sml t TINo
St. ucle ,FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATIQN
Address:
Legal Description: (\LAGv1- 05�1c� - uc�%�- 0�
Property Tax ID#: a-1 0 a_ (0v-I-0Y 000 - - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAIL"FD DESCRIPTIQN QF WORK
wo' _P_r Co(\rve�-,
CONSTRUCTIQN 1NFORMATiON
S
Additional work toflasTank
orme under this permit-check a appy:
HVAC E]Gas Piping Shutters a Windows/Doors
Electric L`_I Plum _bing Sprinklers Generator Roof
Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 3o 0 Utilities:cnSewer OSeptic Building Height:
01NNFR%L_ESSEE CONTRACTOR
Name v 2 Name:
AddressCompany: (4
City: 'V,,S'k - l ea 2 State:J:L. Address C��S N L Bq '
Zip Code: `A3 Fax: City: :Sg,�a5e, 1,64 State:�-�
Phone No. ., .1- 3S�-022Z Zip Code: Fax:
E-Mail: Phone No.^1'11 (^'.1- Z�Z
Fill in fee simple Title Holder on next page(if different E-Mail:
from the owner listed above) State or County License: kLI 213
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEfV1ENTAL CONSTRUCTION LIEN LAW lNEORMATION
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 posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or reearding your Notice of Commencemen Z�� - 64_/�'.
s
ignature of wne Lessee/Agent Sign6ure of Co tractor/License Holder
STATE OF LORIDA �`" STATE OF COUNTY OF FLORIDA
COUNTY OF -ry irk
The forgoing instrumen was.acknowledged before me The forgoing instrument was acknowledged before me
this day of 5-'4f41h4:!4 20 46y this day of I-eh4-l" .20 _4S:_by
n �
(Name of pe son acknowledging) (Name of persorl acknowledging)
(Signature of Notary Publi -State of Florida) (Signature of Notary Public-St to of Florida)
Personally Known .� EI Produ �t c Personally Known e c o
Type of Identificatio _ .o, 'ee �e Type of ldentificatio Pard'i�c EMANUEL GAGE
y: J. MY COMMISSION#FF027y2J
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t+ aA EXPI .� ne 16,2017 :a+�
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Commission No. 'Fo"' �,._ a Commission No. ! op, EXPIRq§6�k 16,2017
(407)39&0153 FloridallotaryServlce.eom (407)398.0153 FtoridallotaryServiee.eom
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS