HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S Permit Number: JCS q �O S 6
1111,h RECEIVED SEP 3 0 2015
pyM
Building Permit Application
Planning and Development Services
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
h'. # .� s
PROPOSED IROVEMENT ATION
MPLOC §kr4ry '
Address:
Legal Description:
Property Tax ID#: 1�2� 1 1 1 ��- (_�W Q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
d ' r 7 aa. r f x a
DETAILEDDE>SCRIP;TIONOFWO:RK s xfi
. ,
r� �
CONSTRUCTION INFORMATION`: t .;
Additional work to be nprtormed under this permit-check a appy:
OHVAC Gas Tank Gas Piping _Shutters l]Windows/Doors
J Electric 0 Plumbing ❑Sprinklers 1-1 Generator F] Roof
Total)Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: Utilities:nSewer Septic Building Height:
OWuNER/LESSEE # CONTRACI`OR
Name Name:
Address: 4q (, W Company: C_ I lc�
City: _ ri& Stater Address:. ti LQ O3
Zip Coder(-L0Aq Fax: City: �_ S`ta`Ite: (,
Phone No � —���� Zip Code:_ I�Z FaxMZ -ttpk
E-Mail: Phone No. z -
Fill in fee simple Title Holder on next page(if different E-Mail: , I L, q , br�
from the Owner listed above) State or County License:t C7 �(>c�1 lQ�-F3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUP PLEMENTAL',CONSTRU;CTIQN LIEN LAW INFORMATION:
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 recording our Notice of Commencement.
-� s
_Signa of Owner/Lessee/Agen Signa of Contractor is rise older
STATE OF ORIDA STATE OF FLORIDA c I
COUNTY OF ` _� C Q��_, COUNTY OF
Thefor ng instram t was cknowledm
gePefore me The forgoing instrument was acl.nowledged before me
this
�y of 20 1 Eby this,?A' ay of P 20 by
(Name of person acknowledging) (Name of person acknowledging)
hLLL& � ���o,%-�'(�u Tx- 0 a a_ M CJV-- quo
Z�
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known 1� OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. 0, 6 ,REQ M Z ion No0 ��o%,11„p,kSea BRENDA MARTINEZ
fW'4r, • Notary Public-State of F Ida
Notary Public-State 1 FloridaMy Comm,Expires May 31, 019
Revised 07/15/2014 �.,,,,nMy Comm.Expires May 31,2019 ��
Pnndrdthrough NRIinnalNotary Ass t
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS