HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I p
Date: Permit Number:
lri~ a �
Building Permit ApplicationN®V -3 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:
PRQPO ED (NP.,ROVEMENT LOCATION
Address: . ' �� L 3
Legal Description: L7 0 �\1 1 (6L Z S R , E
Y �s
Property Tax ID#: 3q- o 2)3-U oo "DJC) Lot No.
Site Plan Name: Block No. .
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK �� t N
lk ce OVA OLi Q_
CONSTRUCTION INFOR'IVIATION X
m;
Additional work to be pertormea 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: Sq. Ft.of First Floor:
00
Cost of Construction:$ C)0. Utilities: _Sewer; _Septic Building Height:
OWNER/LESSEE
ri CONTRACTOR ,
Name [[ I C_ _ Name:
Adw�rr-idress: 0 (�I c ct� . �� r, u CC Company:
City: f-(—_l i e-(- C Q_ State: Address:
Zip Code: D S ,,:g ? Fax: City: State:
Phone No. <W I 1K Zip Code: Fax:
E-Mail: :-CQ a 420 P"IcomPhone No
Fill in fee simple Title Holder on net page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
r
SUPPI EMERITAL CONSTR°UCTION 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 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 addition$.p
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 th�first inspection. If you intend to obtain financing, consult with lender or an attorney before
commeX in wft or recording our Notice of Commencement.
/6 A/1A'4 2�A
oeigiatT� ie—i6%�p,�_ Lessee/Agen Signature of Contractor/License Holder
STATE OF FL,O - STATE OF FLORIDA
COUNTY OF COUNTY OF
. .
The forgoing instrumentAwas acknowledged r fRSrleim( The forgoing instrument was acknowledged before.me
this,3__day of 20 (}t: this day of ,20_ by
0
a m�
(Name of pe son acknowledging) Vii.:;: (Name of person acknowledging)
v
(Signature of tary Public-Sta a of -orid )� (Signature of Notary Public-State of Florida)
Personally Known OR Produced Id fificatio �! Personally Known OR Produced Identification
Type of nti ' a ion r Typo of Identification
Produced �' Produced
Commission No. (Seal) - Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED `
ev. /2014