HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � l S Permit Number:
Building Permit Application RECEIVED
Planning and Development Services /Z 2015
Building and Code Regulation Division OCTl•
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 LOCATIO//N:
Address: Y o.2G Lo
Legal Description: L ,JJ_ �/" t/q,�,�a. ' "ne ���- �7 /_1
Property Tax ID#: 3y�s- >o(E- a-eo 3- O UO ' Lot No.
Site Plan Name: Block No. 37
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF-WO RK 3/W
�;he,e kss jl4if s
CONSTRUCTION INFORMATION.
Additional workto e e orme under this permit-check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: z J 5 Sq. Ft.of First Floor: ,?S7
Cost of Construction:$ 6� Utilities: Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name J� G',e e Name: f?lr.o�
Address: 20 'Cl7r. Company:
City: State: . ` Address: I �l -3,�W ���� ore
Zip Code: Fax: City: 1--'2r`�Tom:, GNU State:
Phone No. �,�. � _I Zip Code: 3/9c?e/ Fax: 77 -3
E-Mail: Phone No. 772-370- -77 7e
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: Ce,--
If
epIf value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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MNWINGI
..`� TMDNEER: Not Applicable MORTGAGE COMPANY. _Not Applicable
Name: Name:
Address: Address:
City: State:______. City: State:
Ap: 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 commented prior to the issuance of a permit.
St.Lucie Count yy make no represegtatlon that Is granting a permlt will authorize the permli holderto build the subject structure
which Is in ontllct watt any applicable Home Owners Association rules,bylaws or and covenants tat may restrict or prohibit such
structure.Pease 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 roams 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
be ore the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
_Signature of er/Lessee/A Signature of C ctor License H r
STATE OF FLORI A J STATE OF FLORIDA
COUNTY 0F COUNTY OF
The forgoing lnstrun)en w s acknowledged before me The forgoing Instrument w $acknowledged before me
this�day of r- 20 !5by this—Lday of d dv r 20 i $ by
S1 g7
V,1,/(-e
(Name of person acknowledging) (Name of pers ckn ledgi g)
( gnature of Nota P blic-State of Florida 0 bl�i (Signature of No Public-State of FI
rY ��ep1UNK� rY OFF 12y134
Personally Known " OR Produce' •. 0� Personally Known��OR Produced
Type of Identification Produced.._-... `` ,2 201as Type of identification Produced ���i,,,,punn•,,"" n \
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Commission No. 22- ( 1) a� ;a Commission No. (Seal)
F X73 ;o
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P���/T'�AYPUBIIC
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
Z0 30vd 8068EVEZZI 85:E0 STOZ/Z0/0Z