HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -E 0 5� Permit Number.
Building Permit Application SEP 2 8 2015
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 s
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR:' To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION =
Address: ,7 Cj C4 cu ci r1
Legal Description:. /1 CIzy 124 i t UJ rl
r 6��
Properly Tax ID#: / 3 0 (, LotNo.
Site Plan Name:S- vy c S 1'1 LG 5• Block No. _
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION O�'WORK _ =
m
CONSTRUCTION INFORMATION _
Additional work toe verformed under this permit-check all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric Plumbing 0Sprinklers FIGenerator a Roof
Total Sq.Ft of Construction: 0 S .Ft.of First Floor.
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Cost of Construction:$ Utilities: _Sewer Septic Building Height:
OWN ER/LESSEE CONTRACTOR
Name u✓cfi 4 Zest Name: t6d 11C
Address: 6`70 CC, /Iersl !14 Ct Company: 114�VZ-
city: State: Address: 03 E A--
Zip Code: 3 Fax: city: F f f come, State: Fc-
Phone No. Tip Code: ��!� Fax:
E-Mail: /(A Phone No.
Fill in fee simple Tihe Holder on next page(if different E-Mail: Ce Q
from the Owner listed above) State or Coun License.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTRUCTIQN UEN tA1N f�t1EQRMi4TIC1N
DESIGNER/ENGINEER: - NotApplicable- MORTGAGE COMPANY: Not Applicable
Name: L g r a d Q Qc)r 0 a Name:
Address: 1 3 5 GJ �rej A.4 Address:
Yh i e wt E� State: PL,, City` State:
Zip: �,�-� K -Phone: D 6 s—� �Y Sri�d Tip:+ Phone:
FEE51MPLE mu HOLDER: 4Not Applicable BONDING COMPANY: 'Not Applicable
Name: Name:
Address: Address:
WY=...
Zip: Phone: Zip: Phone:
I certil y that no work or installation has commenced priorto the Issuance of a permit
St.Lucre County makes no representation that is granting a,permit will authorize the permit holderto build the subject struciture
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
i struduc+e.Please consmdt with your Home Owners Association and review your deed for any restrictions which may afiplY
In consideration of the granting of this requested permit I do hereby agree that I will,In all respects,perform the work
in wwrdance with the approved Mans,Thee Ronda BiAkimg Codes and St lucre CounWArraaWwft
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 fallm to Record a Notice of Commencement may result in your paying twke 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 aur Notice of Commencem
zz
cru:
Sigmmawre of Owner/I eej h! Signature of COnbactor/License H er
STATE OF FLORID STATE OF FLORID Y
COUNTY OF - _ COUNTYOF
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The fo instru adrn mg The g instru was acknowledged befo LU :2
thrsc of 20 %r w thisay o€ 20 icw
P .
(Name of person acknowledging) me of person acknowledging) f
(Signature of Nogly Public-State of F16.4da V (Signature of ryPublf-State of Flrida)
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 VEGEfA11ON SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS