HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,/ •��� Permit Number:
=- M NJ,
_ _ _ - RECEIVE
Building Permit Application
Planning and Development Services NOV 2 3 2015
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
PROROSED IMPROVEMENT LOCATION:
Address: 3vr 1C
Legal Description:
Property Tax I D#: 34 1 —,jd i— id d 6-15-0 3 Lot No.
Site Plan Name: Block No.
Project Name: ":S {o 1SOM
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
kPLACE M 6-ri5(q (CMW661dCV )
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—c ec a appy:
C�HVAC Gas Tank E]Gas Piping _Shutters ❑Windows/Doors
Illectric 0 Plumbing Sprinklers Generator g Roof
Total Sq. Ft of Construction: 33q I S . Ft. of First Floor:
Cost of Construction:$ SBQ i Utilities: _Sewer 0 Septic Building Height:
-OWNER/LESSEE. CONTRACTORc
Name KPlo Name: 2T/ftJ>Z ELNI(Fill
Address: 03 6Ll 0VI L Company: V C7" T� AC
City: eOFF f-r Lucle- State: 6- Address: 7300 (j f0 ( L
Zip Code: Fax: YdPT
�! City: ST 40C(6 State:
Phone No. �7�� gal14Zip Code: 31q.5D Fax: 779--VE It7
E-Mail: Phone No. T)c1 08__- 91'2J'_14/1 77a-370SZ3
Fill in fee simple Title Holder on next page(if different E-Mail: V CA;U'
4 AJET
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLE�MENTALCONSTRUCTION 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:
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, con It with len r or an attorney before
commencingwork or re in our Notice of Commencement//
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Signature of ner/A ent/Lessee Sig ture of Co ractor/License Holder
STATE OF FLORID r 1, STATE OF FLORIDA '
COUNTY OF ' ' A*= COUNTY OF r
''' The for in mstr ment w acknowled ed before me
The forgoing instrument was acknowledged before � g g
this day of 20 14 by p this,�� day of 20y
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(Name of person acknowle ging) y ff 2 (Name of person ac(nowledging)
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(Sig at Fre of Vary Public-State of orida) (Signature of Notary Public tate�&Floricla)
Personally Known OR Produced Identification Personally Known�_OR Produced Idep�{>, llf0.
Type of Identification Produced Type of Identification Produced *.+ O .. R �i
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Commission No. (Seal) Commission No.Ffoy /9a eray�A
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS