HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE:INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: +(`�'�'� Permit Number:
RECEP."I OCT 0 6 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: (7 72)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line v C\C
PROPOSED IMPROVEMENT LOCATION:
Address: ;� (`) f_s-t e D P-
.Legal Description: (^�,�\ Q�JVQJ rro. P
a6u3- dao-�
Property Tax ID#: V-1 O O no6 C-> 1 Lot No.
Site Plan Name: Block No.
Project Name: OA
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Aoditional work to be pertormed under this permit-check all thatappy:
_HVAC Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing ❑Sprinklers 11 Generator 0 Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
w
Cost of Construction: $ w,30C) Utilities: Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 'CLC- � N /U . , ame: (� IZ�V_u_ C, s
Address:! rt e- Qv- Company: AA�r,IScut-, - 0\_I�
City: �=- - �� -� State:_G Address: DL6 CL54,6 'kL-Q_
Zip Code: Q Fax: City: Q41V State:__q_Q_
Phone No. Zip Code: Fax: rJ7 Lp/�t 5)
E-Mail: Phone No.
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Fill in fee simple Title Holder on next page(if different E'-Mail: n
from the Owner listed above) State or County License: �I Cy -
If value of construction is$2500 or more,a RECORDED Notice,of commencement is required.
-
RECEIV770 OCT 0 6 2015
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
comme,n5ft work or recording our Notice of Commenceme
Signatur of Owner/Lessee/Agent Signat a of Contractor/License Holder
STAT OF FLORID ST E OF FLORIDA ����
COUNTY OF 5 . LOC\ C UNTY OF --11�C
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of b c.-k' 20L5 by this (a day of C'S61) 20 AS by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pubk-State of Florida) (Signature of Notary PuRic-State of Florida) z
Personally Known OR Produced Identafivn Personally Known OR Produced Id cfi ion
Type of Identification % `PNPGIa�e otF�O' 0�6 Type-of Identification
e
Produced L QL- - � °bC�c'esoec�6�6� Produced L QL M ��P��c.S�a�eG1616�
No�a� S�P�t EE ago PSso• �a�1 P°6ExP`tes EaSS Psso.
Commission No. -�' My�o �a9)...... °a�N°`ay Commission No. P l'lcoMyGomm(
1011
REVIEWS FRO ZONING SUPERVISOR PLANS VEGETATI TURTLE_. -MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.772014