HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: 3C'� Permit Number: �5d 1'05d�
• , _ ley p SEPM-61- Ma
3 0 2015
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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
PRO;POS'ED IMP{ROVEMEN' LOCATIO,Nw:
s.
Address: l UZ
Legal Description:
PropertyTax ID#: 1L �2�- �L'C�- �� �- - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED}�DESCRIPTION (0F WORK
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CONSTRUCTION I .ORMATIO.N
Acld
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itiona wor to a er orme under this permit-check a appy:
_HVAC EiGasTank Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing ❑Sprinklers 0 Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$� Utilities: Sewer E]Septic Building Height:
OWNER/LESSEE aX CONTRACTOR. .
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Name A Name:
Address: 7,0� Company: _ ? I C
City: Stater Address: Q l "-� t.
Zip Code:3 q"4 Fax: City: State:
Phone No.'—m Zip Code-5LR Z2_ r LK
CFax:O-3 �-
E-Mail: Phone N K
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Fill in fee simple Title Holder on next page if different E-Mail: !�_Q i(_Q_�� �C�� ���C��6'
from the Owner listed above) State or County License: l (_aE2
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU'PPLEM`ENTAL-CONSTRUCTION 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.
_Si a re of Owner/Lessee/Agent Sign t�of Contractor/License Ho 1der
STATE OF FLORIDA L ,Cn_ - STATE OF FLORIDACOUNTY OF ( A COUNTY OF
The for sing Inst talent was a knowledged afore me The orgoing instru _ant as ac<nowledged before me
thi ay of 20� by this ay of 20 �by
(Name of person acknowledging) (Name of person acknowledging)
F_xpmo, Lr�L' V60-?� S� � I
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No ea ssion No 3 BRENDA MARTINEZ
Notary Public-8 Florida �,,,,,1Y';,,,���, Notary Public-State of FI da
ice
A W;
..million#IFF 2211 "emmils
,, . My Comm,Expires May 31,2019 ,� My Comm.Expires May 31, 19
ary
Revised 07/15/2014 ' �4���t;,', BondedthrouphNationalNotaryAssn. �''�°������ 8a�dedthro*Ntional
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