HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TOME ACCEPTED
Date: /� �� 1J Permit Number:
RECEIVrD OCT 0 8 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 here V C
PROPOSED INPOOMENT LO ATIC)N Y: ,
Address: Z6-I &r t 117f
Legal Description: d9n4de1-*1 tfL°Cerdg-
Property Tax ID#: 39Iq' 570 Coe) r, Lot No.
Site-Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
777
DETAILED DESCRlPTIOIV OF W4ftK
z
A h occ /&j
CONSTRUCTION IN;1=0RMATlON x -
Additional work to (rrormed unclerthis permit—cneCK all appy:
❑HVAC L_J Gas Tank E]Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing Sprinklers ElGenerator D Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
0
Cost of Construction:$ ��� Utilities: _Sewer n Septic Building Height:
OWNER/LESSEE CONRACTOft
Name ELU/S Name: a if
Addres 11/ l,J& l S - Company: ! e 0 e- !</
City: 014 L? Cae'_ State:JE.,-- Address:
Zip Code: 6W03 Fax: City: / State:)*_1
Phone No. 77Z—167-1 [//13voZip Code:4710 Fax: 17G�'� ��
E-Mail: Phone No. '7 7 -W, 16196
Fill in fee simple Title Holder on next page{if different E-Mail:
from the Owner listed above) Stat rCo n#y L i $e: AM
If value of construction is$25W or more,a RECORDED Notice of Commencerd4nt is required.
SUPPLEMENTAL 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:
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,l 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.
y�
i attire of Owner/Agent/Lessee Sig ature of Contractor/License Holder
STATE OF FLORi A STATE OF FLORI[ ► `
COUNTY OF _ (/i L�Cl� COUNTY OF ��fz f Lt�cfe�
The,ojoing inst a was acknowledged before me The for oing instrument was acknowledged before me
thisi!1=" day of ,20/ by this day of eY 20fi-3—t1 by
641ruel Tllf' C l�f��e� A ,
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(Name of person acknowledging) (Name of person acknowledging)
X 11111111111 1lilllfl!
,./—_ "",/—___. =_ i s �• b C9
(Signature of Notary - f Ftk (Signature of Nota c-Statr�c�a)*"//t
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Personally Known Produlcation Personally Known OIC�' ' �44ntifi
Type of Identificatio�pp d I o ate;Q= Type of Identification ProduceoLu 0c --
..6 _d O Z2 LU_
Commission No. % '�� e;::JAI) Commission No. � �
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS -VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED