HomeMy WebLinkAboutBuilding Permit Application it
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10-7.j-5- (h Permit Numba- ,
" .s `" s R E C E I D OCT 23 2015
M W ..;
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 X
PERMIT APPLICATION FOR: b0 5
PROPOSED INPROVfMENT`LOGATION
Address: 140to '�AL*440 rZJ) , n1>G4U4
Legal Description:
Property Tax ID#: `30\^ Gcro- 0-Q61- 06d^ 5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK '
CQNSTRl1CTIC}N INF:ORMATiONQ
i 3..
Additional work to be pertormed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors:
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction:
Gj Sq. Ft. of First Floor: Zd io LI✓/W(01 ST57 WAK,
Cost of Construction: $ �f Utilities: :k_Sewer _Septic Building Height:
OWNER/LESSEE 3 34
CO
. ..� NT RAC
TOR ,:.
Name r' Name:
A.')OrA
Address:36�2-.��bj ��✓I.i�� � Company:�A4:Ts� GdW.,7'
City: PO .: 'Ae Stater Address: l4WAS WA u
Zip Code: ::;;� !r Fax: City: h 'I GZ7f1 State: �-
Phone Zip Code:_3&1540 Fax: 772,- VR&,-0a$
E-Mail+! - � 5Phone No 7Z-- '5S-'9 0
Fill in fee simple Title Holder on next page(if different E-Mail t ew.*,
from the Owner listed above) State or County License 666- OS'* O
Ift
of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUP.'PLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
�.
DESIGN r .:.„ ,.F
_., .. MORTGAGE
ER/ENGINEER: =Not Applicable 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 thepermit 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 Commenceme
Signature of Owner/Lessee/Agent wriature oftracto /Lic a Holder .
STATE OF FLORIDASTATE CF FLO ID `
COUNTY OF s�• �-Uc COUNT OF
The forgoing instrument 1was acknowledged before me The for oin instrum t^wase 4nowled e b me
thisa3 day of OcG 1 ,2015 by this,2ny of �y J 20�
cA(Name of person acknowledging) (Name of person ack o ledging)
t
(Signature of Notary P lic-State of Florida) (Signa Ublic-State of Florida)
Personally Known OR Produced Identi is •i ersonally o oduced Identification
Type of Identification Np '\'JO°�Flo+�a16 Type of Id¢nt" k, N01or q.
Produced LQL tib° PUb��°.SkSoeC�6,2� uce ";c..."-,,.�,;,�r;;;�� a yp cC
„r„ No�aty ExP+ce EE a5g�0 psso. Stade
Commission No. ` .My�5$ �s+o�# a�N°ka+y ommission No. ��r. +AFF o eal
oadedth�
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REVIEWS FROM NING SUPERVISOR PLANS VEGETATION SEA TU MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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