HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �7
Date: �� / %S� Permit Number: 1J7 V - y 0 c) �.
= v..k d � RECEIVED
>�- OCT / 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:
PR R POSE
Dt,INPR'Q1/EIVI`ENT LOCATION
Address: /°737 Al GU ?,Lr.-tIorJ B u. s!.i
Legal Description:
Property Tax ID#: o� ����-fit JD -�. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
COIVSTRUCTI{ON INFORMATION r3; £z
as
ACICI itiona work to be performed under this permit—Check all that appy:
_Mechanical '' _Gas Tank _Gas Piping Shutters _Windows/Doors
%Electric`` _Plumbing _Sprinklers _Generator _Roof
Total Sq.,Ft of;Construction: c_3 0?00. Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: Sewer _Septic Building Height:
OWNER/LESSEE � CONTRACTOR
Name Name:—
Address: 0Y) A; w Company:_��, / ,c_a, Iec`tu vg- (1L
City: A-104 Q,o�, , ic-(- State: Address: /c1�t a,a 5' . cab 19Mb—/A&
Zip Code: 3 c14 F o' Fax: City: 10's. L- State: tF I
Phone No. 7)9- &(D6n 9 3 7' Zip Code: 3 U 93a Fax:
E-Mail: I<C SLNLaLU�a� /3 c. ��„da� � Phone No q-
Fill in fee simple Title Holder on next page(if different E-Mail =.ufr,
from the Owner listed above) State or County License 624ff91A7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN I.AVU 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:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
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.
Sig a wn essee/Agent S' ure Cont r r/License Holder
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COUNTY OF
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STATE OF FLORID b: STATE OF FLORI '
COUNTY OF 'a, . t=
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The forgoing instru�nAt wAas acknowledged before m�a The for oing instru ent was acknowledged in
this / day of ( ,20 by 2 D this day of 20 �0
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E2n l.-��/chi a� v�t w Lot1/&i I 5
(Name of person acknowledging) r, (Name of person acknowledging)
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(Signature of(Votary Public-State of Flori a) (Signature of Val Public-State of orida)
Personally own OR Produced Identification Personal Known OR Produced Identification
Type of Id ntifi io Type Iden ' is tion&
Produced .�.Ci� L. Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014