HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 /
Date: Permit Number: �(
RECEIVED
Building Permit Application SEP 2 9 2015
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:
PROPOSED INPROVEMENTLOCATIC►N K
Address: 32O G S _ t_, Lz- i,> C`. sc_ s ?i e.CCf , 3 ef90qvv% �- /I 0
Legal Description: 0 0 -
Pho'_S .0- '1- tR L,0 b 1. - 1 t o
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
,1 'v ff $ 3%:A
4 S$YX 45
DE`CAILED DE5CRIPTION OE WORK
l vAQVC / I e.r,le_ StJ, v1� G (G s5 JQor5 ,
CON, Sl'RUCTION 1NF,,.ORMATION �� � �'
.
Additional rk to b e performed under this permit-checK all that appy: ..,
_Mechanical _Gas Tank _Gas Piping _Shutters L Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 7. 5 O Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE~ r=
CONTRACTOR
J_, ,,...
Jwl Name: IA«s1.4
�
'Address: �--0 S c J ( o.Li-'��' S Company: C* I����n r-)
City: i �,c�w� State: F1, Address:: (7-)-,o Coe >1�✓ter I��(
Zip Code: 3 3 i S (® TFax: City: ra(•- f e C c.e- State: L
Phone No. (3 o!' 3 3 t - 0 a Lf 2 Zip Code: 3 Li cf L-f S Fax:
E-Mail: Phone No C-27-1) 5If - 2 0 3 G
Fill in fee simple Title Holder on next page(if different E-Mail+(Gc c oa.i c r-e,, eon
from the Owner listed above) State or County License C G i S �'-1 g q
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
r
SUPPLEMENTAL','CON5TRl1CTION LIEN LAIN 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.
Signatur Owner/ essee/Agent Sig ature Contractor/License Holder
STATE OF FLORIDAr' STATE OF FLORIDIt
COUNTY OF c�r �U0 COUNTY OF
41 0 C-A-9--
The forgoing instrument was acknowledged before me The for oing instru ent as knowledged_hefore me
this day of �j2�� 2W5 by this_day of 20by
00' pop ,.lex a6o( �eurn C LA'78nI P)E-C_V0J
(Name o erson acknowledging) (Name of ac Howl'dging)
(Signatu�VyKnown
of Notary Public-State of Florida) (Signature of Notary Pu lic-State of Florida) /
Persona OR Produced Identification Personally Known OR Produced Identification
Type of Identification , 1 1 --7c+ �a�— Type of IdentifIca tio
Produced —L Ue� h� Qroduced 'd
NOTARY PUBLIC LEEN SUE H AY E S
Commission No. F X337 I A���'�� Commission No. _ 11(iSeab)n N FF 209728
Cpmrn*FF233'18� s, o d My Commission Exp,ios
F�cplres$l21I2019 March 15, 2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014