HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t - � Permit Number:
i RECER"ED NOV 2 5 2015
o �
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: A-1 1 Gtr
PROPOSED INPROVEMENT LOCATION;
Address: �k
Legal Description:
Property Tax ID#: � 5 � b) - C���'7 Uo � ^C) Lot No.
Site Plan Name: Block No.
Project Name: y�y`�- C'�✓`�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIMOF WORK:.,
ky
CONSTRUCTION INFORMATION:
itio or to a pe orme under this permit-check a 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:
c.,
Cost of Construction:$ c 6C Utilities: _Sewer _Septic Building Height:
OWNER/LESS.EE:
CONTRACTOR:
Name r Name: L c
Address: 1096 N- Compan GVQ
_
City: PA-0 State: __ Address: d 0- //
Zip Code: a��q o Fax: City: � Q kK4 Stater
Phone No. Zip Code: 2 � Qka Fax: Lca( -51 yl�
E-Mail: Phone No 1?7Dr LJ U,I I
- `
Fill in fee simple Title Holder on next page (if different E-Mail )k'0 2 O},
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU.I TLEIVIENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not App MORTGAGE Applicable 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 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 rec ded and posted on the jobsite
before the firs spection. If you intend to obtain financing, consult W. I nder or an attorney before
commencin rk or recording our Notice of Commencement.
Signat essee/Agent Si t actor/License Holder
STATE OF FLORIDA 5k �v c� COSTAT OFOFFORIDA 5'h .
COUNTY OFTy TY
The for oing instrume�}t was acknowledge before me The fo�oing instrument was acknowledged before me
thisa day of'N 20_ by this day of 201S by
�aSdT\ toil) se- Sa,r` 5�itb �g�
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu -State of Florida) (Signature of Notary Pu ic-State of Florida)
Personally Known OR Pro>_'c
- le�Atligatro`'i Personally Known OR Produc ��gp€i ��tio� �6
Type of Identification POMP S�a�oe°1���61PSs� Type of Identification � � ���c SeSoe°.C' eS °�� PlOduced F�+ ��.._� cue hyo 4- a�yps
Produced L L u a `� �a # of
y,,,a:`"" ��o�•\ss�0a oU°�a�C1
� ,..�',0 �o S ��u Commission No.
Commission No. � � ��
COP
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COUNTE12., REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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