HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_iD) IC0 7015— Permit Number: /,Y) 0- .
RECEIVED
Building Permit Application
Planning and Development Services OCT 16 2015
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click here
PROPOSED ROVW'
Address: 4. Lon nins I (M-P .
.e,
Legal Description: naJ
61-19_0b-
Property Tax ID#:Pee# 0-b 15!5 (M41 q 16 CL MZJ 3 Q?) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED
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CONSTRUCTION
INFO
Additional work to be performed under this permif-Meck all that'appy:
0HVAC Gas Tank F]Gas Piping FIShutters F-]Windows/Doors
Electric Q Plumbing OSprinklers, LJ Generator 13 Roof
Total Sq.Ft of Construction: So.Ft.of First Floor:
14rt (JD_ 11 Sewer F]Septic Building Height:
Cost of Construction:$ Utilities:
OWNER/LESSEE
Nameflalrj K1_I X. ep Name: UeJ -I-, D U 1-MM
rv�l
Addre-qs: LAIS 045 (lei Company: dyafth%
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IN' L
City:j Uxm State:EL Address: Qt
. 1�3_4 C i�%
Zip Code: LAf�2- Fax:Xf— City: t I&C/3010-— State:9e
Phone No. 0 10 - ?,Zp 2_ Zip Code: ---WC)62- Fax:_17?__t90(5_Qq(F11)
E-Mail: Phone No.-I
Fill in fee simple Title Holder on next page(if different E-Mail: 1 l -COO
from the Owner listed above) Statenn ountY ?rise:
1 NZ-11,poce-It-
If value of construction Is$2500 or more,a RECORDED Notice of Commencement hHequired.
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 TITLEHOLDER: _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 Countymakes 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 your Notice of Commencement.
4.A?4�
V11i �alvlall ,
r t*iKature of Owner/Agent/Lessee Sig azure of contractor/License Holder
STATE OF FLORII(A STATE OF FLORI
COU OF COUNTY OF Etq..--t 1"�"
The f . t icknowledged before me The fa Inst me t k
,grqng ins e t was a going ins nas acknowledged before me
_U by er [Mby
this ay of?7=bW ___,20 this16 day
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{Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary r6f Nota ub Stat n
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Commission No. % Commission No.
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Revised 07/1512014 ......
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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