HomeMy WebLinkAboutBuilding Permit Application Nov 0415 02:11 p p.1
ALL APPLICABLE INFO/MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / �• `� / Permit Number:
RECEWED
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Building Permit Application NOV - 4 2015
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 V
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-IMPROVEMENTLO--CATION::: :.,,.-..Address: Z 60 /(/ r,G�� / 4
Legal Description: 0C gaa Ffrl�-h or SCJ -h 121,4a (/Ar f 416 ate►cl I 1 n A
PropertyTaxlD#: 0/zz —000— ( Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: RightSide: Left Side:
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CO N5TRLICT.IO N.INFORMATION-:
ACICIrtional work toflasTank
orme under this permit-check a appy:
HVAC Das Piping Shutters Q Windows/Doors
11 Electric ®Plumbing Sprinklers LJ Generator Roof
Total Sq.Ft of Constru ctlo n: SFt.of First Floor:
Cost of Construction:$ J�SQ`� utilities:t SewerF1 Septic Building Height:
OWNER/LESSEE: ,:CONTRACTOR:.:
Name GLrrO� ��"G�YlGC4tG� Name: _6seph-roty
Address: 1U Alahu[Q AIA l0 Company: Gone�►is kambina Ser 'it G,5-rnr—.
City.. plerr-L State,__E6- Address: IgCa SE zalt p, p1m
Zip Code: 2 gLl9 Fax: city: 1?brjc St. I_cic:tf_ State: 5L
Phone No. Zip Code: agaS7 Fax: 7:7_M-D.60
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: C.�enc�.sis`{�lt�rr�ori� �eN�L pG m Orn
from the Owner listed above) State or County license: I 6
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Nov 0415 02:12p p.2
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERJENGINEER: _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:
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 of Commencement.
S
ure of Owner/ essee/Agent ature of Contractor/License olde
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF L v cZe COUNTY OF__ ist, L UQPI
The forgoing instrument was acknowledged before me The for oing Instrument was acknowledged before me
this day of�!A/GvLs�lf , 2D lSbp this day of /1—love t kr ,20 L by
0 5 T`ly _ _ �a�colt ✓if
(Name of person acknowiedgi g) (Name of pefson acknowledging)
(Si of Notary Public-State of Florida) (Sig ture o -Notary Public-State of Florida)
�PersojnallyKn�o uced Identification ersonally Known Produ�uced y w . `1 0 o cfA �1 EXPiREScoRdMfSS! Ar F9latlti6 Com �ealf t CommissB bar G1,2aaa►i iat-0��
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR I PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS