HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:Js
--_�- - -^-�-___-_----- 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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
Address:
Legal Description:$�/ � Phey, TU o I+
Property Tax I D#: �j�i q — 510- a Zq 4-000—T Lot No. �3
Site Plan Name: O(M,v Block No.
Project Name:
Setbacks FFefit B Right Side. :
DETAILED DESCRIPTION,OF WORK R
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CONSTRUCTION IN FORM'4TION
Aciditionalwor-k-t-o-opnprrormedunder this permit—check ail apply:
HVAC 0Gas Tank _. ❑Gas Piping _Shutters OW doves/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ iL '-S (:)C) Utilities:�Sewer Septic Building Height:
OWNER/LESSEE A r CONTRACTOR r
Name Name: CVWXSvo�
Address: q Company: C
City: Q State::FL Address:
Zip Code: _294252— Fax: City:T4. VIDcre Stater
Phone No. 1'1 Z S39 '7 5 Zip Code:__!:N -191 Fax: N I
E-Mail: NTk Phone No. 5
Fill in fee simple Title Holder on next 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.
SUf?P,LEMENTAL CONSTRUCTION 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 TITLEHOLDER: _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 ult in your paying twice for
improvements to your property.A Notice of Commencement a rec�Ittorney
lae Lobsite
before the first inspection. If you intend to obtain financin onsult with befor�
commencing work or recording our Notice of Comme ment.
" ignature of Owner/Lessee/Agent Si a of C ntrac
STATE OF FLOIDA STATE OF FLORIDA '
COUNTY OF G �n t- 1,sC12. COUNTY OF -57',).uC-t le--�
The fogoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this � Dday of /y0VPm)9x— 20 L'�_by thiso�6§ayoffVoV&Mbe-2 .2015 by
(Name of person acknowledging) (Name of person acknowledging)
t?rl sa", P4-'e� - Qy�_ 0.piwlwl_a�
Asignatur&of Notary Public-State of Florida) (Signature of Notary P/' -State of Florida)
Personally Known OR Produced Identification Personally Known l/ OR Produced Identification
Type of Identification Produced �Q�L�� Type of Identific .
JC�dtaDAWEQN PRESSLEY �'"r " ' GAIL A I EY AN
Commission No. Public,Statoof Florida Commission No. Notary Public ��of Florida
Commission#EE 871404 =;,• •�o GAy Commission Expires Jan 4,2018
•i�rF PC,.
My eemm, . r 4,uuN
Revised 07/15/2014
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