HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST-BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 Permit Number:
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RECER-.'D OCT 04 2015
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
PROPOSED-IMPROVEMENT-LOCATION.
Address:
Legal Description: ,:i- �CD I
Property Tax ID#: a / J3 6 0 Lot No. Z3
Site Plan Name: !/Y If< Block No.
Project Name:
Setbacks 'Front Back: Right Side: Left Side:
DETAILED DESCRIPTION bF WORK
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CONSTRUCTION;INFORMATION:
dAdditional work toe nerlormed
: under this permit-check all apply:
HVAC Gas Tank Gas Piping _Shutters (�Windows/Doors
11 IL
Electric El Plumbing Sprinklers I Generator 0-Roof
Total Sq. Ft of Construction: S Ft.of First Floor: f
Cost of Construction:$ d�,���C/A Utilities: _Sewer Septic Building Height:
OW ER/LESSEE CONTRACTOR.
Name Name:
Address: �
City: G State:&- Address: /00-6 6),a
Zip Codd ( Fax;&a-!017- 1, 19-®? City: A3 L- State: r_—t,
Phone No. 7M �� �J -- �' Zip Code: 3'ttgS3 Fax:777-8'7`7-16-02
E-Mail: T Phone No. -7-12,- 4618
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Fill in fee simple Title Holder on next page(if different E-Mail: a d�ea ez I J-e,—A/ykc, e q,-ko 6, co
from the Owner listed above) State or County License: CA6_ d q e-f-o
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL,CONSTRUCTION LIEN•LAW INF,ORMATION:;;
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: 1 A Address: 1
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 14 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.
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID %, STATE OF FLORIDA
COUNTY OF LvGy COUNTY OF iz Zt'ice. -p"
The forgoing instr e •was acknowledged before me The forgoing instrument wasknowledged before me
this%a day of 20�by this`L day of 20 �'�y
(Name of person acknowledging) (Name of person acknowledging)
4( gnature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
P r OR Produced Identification sonally Kn OR Produced Identification
Type o Iden " ' _;& Ty ;,, ,
°; Y°�a'• KIRK ARI KATZ "��"vP&�e KIRK ARI KATZ
Comm 46n N#FFO( Commissio o.: MISSION(a %144924
oP 2017 + .''g`°Y EXPIRES August 12.2017
':4 ••�a,,. EXPIRES August 12, ,�•--
••�
(407)390.0153 Flor a o a '
Revise 7/15014 �"
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS