HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10-L-5— �r7 Permit Numbe.L
RECEIVED OCT 23 2015
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: 60 � 5
PRO„POSED tNPROVEMENT LOBATION
Address: 740to tzi.)
Legal Description:
Property Tax ID#: 03d�"' G 064 'S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DfTAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATIO[tf
_
..
Additional work to be peFFormea under this permit-cneck all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors,
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: 716 Sq. Ft.of First Floor: 2.0 to 41VI/VfiI ST57 TffrAr(C
Cost of Construction:$ �, Utilities: Sewer _Septic Building Height:
OWNER/LESSEE : h s i .CONTRACTOR
_ t .. .. r �Q a
Name ` Name:
Address: Company: JJA ff!!N C&AV -dGY
City: �9h 0 :.: State: Address: 41547 SW RAMS WA !,041
Zip Code: �30rOr .l' Fax: City:. GZ7� State: �-
Phone No.f�G'��... �� 721 Zip Code: '5& g0 Fax: 772,1 ZVfo-OW
E-Mail: a Wmaox tio— 0 Phone No 177,- 151'5 o
Fill in fee simple Title Holder on next page(if different E-Mail "&&-t .CeoJy
from the Owner listed above) State or County License 66cG OSCE p
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIQN LIEN LAW IN1 ORMATION
. . .
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 rion-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 t.
Signature of Owner/Lessee/Agent 33i9nature of'Con racto /Lic a Holder
STATE OF FLORIDA STATE , F FLO ID . c
COUNTY OF s�• Uc �� COUN OF
The forgoing instrument was acknowledged before me The forgoing instrum t^wasfcknowledge b me
thisa3 day of Oc,� ,20]5 by thisCay of �y J 20�
'� Gb,t r- f RdU Sly. �� )�-1 6—
(Name of person acknowledging) (Name of person ack o ledging)
(Signature of Notary P lic-State of Florida) (Signa Ublic-State of Florida)
Personally Known OR Produced IdentiftAtir, ersonally ntd oduced Identification
N '
Type of Identification lr �EPNNp s` o`F�oc2o,6 Type of
a ,�,r� N®' yA��FC
Produced L ub��c PC 1b,
' No�a�y P Exp�ce#EE 9yg1`6 Pss�• _�.90��'oryj�ass/o,��Slade GF ro
Commission No. ;My� �s�on a�N°gay ommission No. a �"FF oeal
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REVIEWS FRONT KING SUPERVISOR PLANS VEGETATION SEA TU MANGROVE
COUNTE REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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