HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J [—� m /� _
Date: �` �J J� Permit Number: ly I U- U
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Building Permit Application OCT 2 1 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: To Select from dropbox, click arrow at the end of line
PROPOSED IM'PROVEME,NTLOCATib'W,
Address:
Legal Description: W" 0 q 3o 46
Property Tax ID#: 7q6�_ 5'09 _Q �� — ^ /
Lot No.233
Site Plan Name: , f Block No.
Project Name: U/;1d -,�"7 &n
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION-OF WORK:
`CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit—check all appy:
HVAC Gas Tank FGas Piping _Shutters ❑Windows/Doors
Electric ❑Plumbing Sprinklers ElGenerator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ � Utilities. Sewer E]Septic Building Height:
OV1/NERAESSEE; CONTRACTOR:
Name Name: UWe a
Address: 19 Company: a
City: 94etlaf ttn State:OiC Address: r, oY �t/�
Zip Code:TZ Fax: City: &C 'e State:
Phone No. Zip Code:-3 Y26-7 Fax:
E-Mail: Phone No. ?a�J/O�70a
Fill in fee simple Title Holder on next page(if different E-Mail: _ a -
from the Owner listed above) State or County License: 7'
if value of construction is$2500 or more,a RECORDED Notice of Commencement 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 TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: 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 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 omrn cement.
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Si nature o n ra icense Holder � =
_Signature o wn see/Agent g j
STATE OF FLORIDA STATE OF FLORIDA '90^
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COUNTY OF o COUNTY OF o
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x The forgoing instrument was acknowledged�efor o�
The forgoing instru e t as acknowledged be cMK rn
this day of 20 3� this�� day of S 20 N by "-, m
c�T9 •2 SOS
\/I//pJI A co Op • c S��
(Name of person acknowled i g) (Name of person acknowledgingN 1
(Signature of rytary Public-State of Florida (Signature of No ry Public-State of Florida)
Personally Known ORq'r d Identifcation `� Personally Known OR P;e ced Iden it ca tion
11
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS