HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: �;�`D "�,� Permit Number:��_� v �
_ . RECEIVED
Building Permit Application SEP 2 8 2015
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential t/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of tine
PROPOSED IMPROVEMENT LOCATION:
Address:. (0 C4�'v(d C01,I( a
Legal Description: l► e 'F, r co),-F, QY�
Property Tax ID#: 3 o Q d —r- / -o O o - Lot No.Site Plan Name: ��� v►,5 {1 LAS. Block No.
Project Name:
0
Setbacks Front Back: (tight Side: Left Side:
DETAILED DESCRIPTION OF'WORK:
17 ' 4dt
CONSTRUCTION INFORMATION:
Additional work to bg ILerformedunder this permit-check all t=apply:
HVAC Gas Tank []Gas Piping Shutters L...1 Windows/Doors
11 Electric 0 Plumbing Sprinklers OGenerator M Roof
Total Sq.Ft of Construction: 3 0' S Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer n Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name ✓j'- 2.x_-✓ Name: Cs C
Address.--6-Wt U. rh r?GK l (4 ('t Company: -
City:_, T ��c-u tee.. I State: FL-- Address: 4 C 0 3
Zip Code: 3 Fax: City: F f t t;p-c-� State-_25c-
Phone No, Zip Code: ��j�� Fax: ' {��
E-Mail: Phone No.
Fill In fee simple Tille Holder on next page I If different E-Mail: Ltu,,Cre4ei-qv
from the owner listed above) State or Coun icense:
If value of construction Is$2500 or more,a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERANGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
W. State: City: State:
Zip: Phone: Trp: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
Zip: Phone: Zip- Phone:
1 certify that no work or installation has commenced prior to the issuance of a permit.
st.Lude 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 Tenants 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,l do hereby agree that 1 will,in all respects,perform the work
in accordance with the approved Mans,the Ronda Building Codes and St.Lucie County Ameredumb
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 ftfirst inspection.If you intend to obtain financing,consult with lender or an attorney before
comm work or recording ur Notice of Commencement.,,-,?
_
Signature of Owner/Lessee/Agent 5igriature of Contractor/License=r
STATE OF FLORID STATE OF FLORID
COUNTY O �., CUNTOF----
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The f ng iofrutru admowledgW Z� instry t acknowte50 CL y�d��g 1b�efore m
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(Name of person acknowledging ct (Name of pea ging)'
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(Signature of ry Pub - orida) (Signature 6f ry Public tate of Flo ' a)
Personally Known OR Produced Identification Personally Known /OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS