HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: • I rJ Permit Number: IS
1
RECE IVED
Building Permit Application DEC 0 3 2015
Planning and Development Services
Building and Code Regulation Division PFR!,UTTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie Coun , FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
'P,R'O,POS`ED'IMPROVEMENT,LOCATION
Address: -SC9 10 && �( Drru_
Legal Description: umbo (zT_Uf_-qz lTt S UWIT R —
Property Tax ID#: 3'-/Oa-60ri- 06/0 Oct - Lot No.
Site Plan Name: Block No. (r?
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED;DESCRIPTION OF WORK: ,'
9.,E M O V E A iJO `2tf UkCT 14vc- W-k w- \Af-akT -UZ-
CONSTRUCTION,;I,NFORMATION
Additional work to be ertormed un er t is permit-check all=apply:
HVAC Gas Tank ❑Gas PipingMGenerator
Shutters Windows/Doors
FlElectric LJ Plumbing OSprinklers Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ S_�o .c¢) Utilities:cn Sewer ElSeptic Building Height:
OWN`ERAESSEE: CONTRACTOR:
Name Name: L7AUTO K05VA-Pk _V,
Address: Company: DJ1V%J'`S `Ply A462TV6 , A/('
City: unz�_V�« State: L Address: L/9°i SE S I; fl-L& = IT
Zip Code: -3 Sr)- Fax: City: �I Ukck State: �L
Phone No. %U-91142 Zip Code: 'JL( 90,L_( Fax: '772?-W-71 X-?
E-Mail: Phone No. '770L-
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: F-L 05 1 6 a5
in
of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUP=PLEMENTAL�CON'STRUCTION LIEN;LAIN INFNOR{MATION«
'R,°}`r.F.,.,. r'„:.,,
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 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 TOO WNER: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, su h lender or an attorney before
com work c-oxdin our Notice of Commence ent
s
_ ignature of�6wnee/Agent n Z/reof Contractor/License Holder
STATE OF FLORI STATE OF FLORID
COUNTY OF 112L( S � COUNTY OFT ,
The forgoing instrum nt was acknowledged before me The forgoing,instr ent was acknowledged before me
this�day of �� �p 201�by this 2day of 20 L by
(fcclpcp� I
me of person acknowledging) (Name of person acknowledgin
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identifica Personally Known OR Produced I
dentification-
ca i Type of Identificatioff
pA
:.= MY COMMISSION#FF 193291
z :,•, MY C0 PAV N FF 193291 ;;:;;
,a
Commission No. :.: IRES;M119 Commission No. #`::• EXPIRES:A( =)2019
off`° Bonded Thai Notary Public UndewdteB '•f„Af�� nded Thru Notary Ptitilic Undewritete
8�,ft'
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS