HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit.Number: Q - 1a
RECEIVED DEC 18 2015
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 w v\aa� pdd
PROPOSED IMPROVEMENT 0CATION, .-.
Address:�•y ZS
Legal Description: V _ A,
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Leff Side:
DETAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION:
_.. :w
itiona wor to orme under is ermit–c eck all that appy: -
HVAC Gas Tank Gas Piping Elenerator
Shutters ,windows/Doors
OElectric Plumbing Sprinklers D
Total Sq. Ft of Construction: S . Ft.of First Floor:
QA
Cost of Construction:$ ,�I'C�Q Utilities: Sewer[]Septic Building Height:
OWNER/LESSEE: 'CONTR-ACTOR ,
Name .C,1ZQ • Name: 0
Address:C\`a `S FJc,�Sn)rn V)A-",) Company:\�,)\,r\d ow 'a0=Qp 1 Y" —1
City: n10 \Q rk, State:!�-_L Address:\-\Qn A�\j . I f\
Zip Code:'S\_VA�� Fax: City: State:C L-
Phone No. Zip Code. Fax:��,\
E-Mail: �mcm . W1 Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: w.rdr,.r YX\ - G0VYI
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN-LAW fNFOR'MATION;'
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 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.
r Signstu of-CiwnerfLessee/Agerit`� Signat, pf_._�on actor-/-License Holder
STATE OF FLORIDA STATE OF FLORIDA) `^
COUNTY OF 57 T Gyice/£ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ejec drn/Wn— , 20 13-by this\-' day of�„ti Qe/ 20Nn�_by
(Name of person nowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary ub State of Florida)
Personally Known OR Produced Identification Personally Known` OR Produced Identification
Type of Identification Produced_4eeC 64?0 wK%150 S ugO Type of Identification Produced
Commission No. 0!211121%. Seal) ission No. (Seal)
IS SCOTT ANDERSON
Notary Public•State of F ride
C Fi �`, My Comm.Expires May 20,2019 NOTARY F'UEtIJC
Revised 07/15/2014 • ”' Bonded through National Notary Assn. STATE OF FLORIDA
ng FF244244
vs 8/24/2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS