HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 5 `d
. - - RECEP.'7D OCT 151015
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: p M�
To Select from dro box, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 2=2D 1PI a 4 9%eirce FL
Legal Description: (,-, Z 12& S - LAn :4C S�\Z- Lek- C:�
Property Tax ID#: Lot No. S
Site Plan Name: NIA Block No.
Project Name: N /A
Setbacks Front / Back: / Right Side: Left Side: /
DETAILED DESCRIPTION;bF;1NORK.
+ale w M -Ve(�,V - t -Vo(-CV� doVjn rood an
YeAa<< Com. v v
"CO,NSTRUCTIO'N' INFORMATIO"N. ;
Additional work to e e orme under this permit-check ec a appy:
HVAC D Gas Tank Gas Piping _Shutters W'ndows Doors
❑ a ,
11 Electric �Plumbing Sprinklers FIGenerator _Roof
Total Sq. Ft of Construction: •ZZQ S Ft.of First Floor: 1-11Cost of Construction:$ �l �CoJ�,( Utilities:Sewer OSeptic Building Height:
01NNER%L'ESS"EE . ".`,
CONTRACTOR.
Name Name:
Address: 1 01nn Company:
City: State: Address
Zip Code: Fax: JNJ14, City:R"- !PA 9-yr. Q _ Stater
Phone No. 1_)2-31 -!442_'9 Zip Code•2A7�1 Fax: /A
E-Mail: �J J,& Phone No. 2
Fill in fee simple Title Holder on next page(if different E-Mail: YV10u ,
from the Owner listed above) State-or County License: Q
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Mar 17 01 05:23a Collins Roofing Inc. 772-489-6505 p.1
ME
NO,
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S. "3.��. �
DESIGN�/ENGINEE _Not Applicable MORTGAGE COMPANY: A p icable
Name: Name:
Address: Address:
City: State: City: State:
Zip: s 2 Phone:�4- d 2i Phone:
FEE SIMPLE TITLEHOLDER: _Not A BONDING COMPANY: Not A li
Name: Name:
Address: Address:
City: City:
Zip' Phone: Zp: Phone:
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 orand 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.
Inconsideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance withthe approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: om additions,
accessory structures,swimming pools,fences, signs,screen rooms and accessory uses t er non-residential use
WARNI NG TO OW ur fail to Re rd a Notice of Commencement resu ya aying ' ice for
improvements t op N ' of Commencement must b re rde nd ed he jobsite
before thefir In Ion y i obtain financing,cons it o n before
commend o r r rdi i e of Commencement
• s
_Sign re of Owner/L e/Agent SignaXumof b6ntractor/Lkeffie Hol er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF isT 1-,Lt C/ Q_, COUNTY OF:f,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of20 L'�Lby this,�5 dayofLr.i 4P_P_ .20 LS by
iy�r�-ems �a ! (S ZZ-i Ais
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notar P Ii -S t f orida} Signature of Notary Public tate of Florida)
Personally Know �'� Produc4d IdentifiM- fhbn Per3onally Known 1--'OR Produced Identification
Type of Identifica Ota pr Nolary: State of Florida Type of identification Prod
ZNWt;0'- •..n Expires Jan 4,2018
Commission No. 1 �FF 074781 Commission No.F-D'r w%y; (SealiAll A..v
EYftAN
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''•,.°,;,:;,.� CanrrtlssIon if fF 074781
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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