HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � 0+ ).\ Permit Number:
RECEIVED
• - �_ - _
Building Permit Application DEC 2 2 2015
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
PRO"POSED IMPROVEMENT LOCATION "``.
Address: /060D S 0C.&- Y/V DZ /O/ �JOVSOV /�,",,--
Legal Description: O C-&-ANA -5o ,-r,4- Coti3OU ff, UN 7T/ /y/ fI'�'1/D Ute/!/_5',Z '/'[c
/N G o A�,? C—G&119C,,,p.-TS ��n- rs 6 3
Property Tax ID#: '/r//- S-t*? —000 B- coo- 4/ Lot No.
Site Plan Name: C4-6a .-f- Block No.
Project Name:
Setbacks Front Back: ight Side: Left Side:
DETAILED DESCRIPTION OF WORK:,
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CONSTRUCTIDN 1NFORMATlON
Additionalworkto e e orme under tis p a al
e ,
ermit-c-check a appy:
OHVAC Ei Gas Tank []Gas Piping _Shutters Windows/Doors
11Electric ❑Plumbing Sprinklers 1:1 Generator _Roof
Total Sq. Ft of Construction: 00 SFt.of First Floor:
Cost of Construction: $ /�]SOu Utilities:n Sewer Septic Building Height:
ODUNER/LESSEE s = CONTRACTOR
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Name Name:
AdCompany: /
City: ,`�� r'l'(iltq / L State:_� Address: t'
Zip Code: "" Fax: City: State
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Phone No. 0:7 - Zip Code: 3qgez L.1 Fax:
E-Mail: Phone No. /2 'O D cl 0
Fill in fee simple Title Holder on next page(if different E-Mail: M G/ 0Vvi/-40
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPLEtUIENTAL C(3NSTRUCTIQ`N LIES IAUV 1NFORMATIaN
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 yopaying twice for
improvements to your property. A Notice of Commencement must be recorde an sted on the jobsite
before the first inspection. If y intend to obtain financing, con attorney before
commencing work or recordipA yg4r Notice of Commen ent.
Oil
s
_Signa ure of ner Lesse Ag re of Contractor/License Holder
STAT LORIDA STATE OF FLORIDA
COUNTY OF :/1Z;9 ,�,j COUNTY OF
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this/ _!Z ay of l��C-- 2045 by this/,?*aay of ___,20Z by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Sign at of-Notary Pub ic-State of Florida)
Personally Known OR Produced Identification Personally Known L--'--OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. °tib"v''••, All J,' Commission No. "'J A . UMOND
IY COMMISSION#FF 173907 A rl MY COMMISSION#FF 173907
EXPIRES:December 7,2018 a., EXPIRES:December 7,2018
.....
„ ,Rs.1.
Bonded Thru Notary Public n envrders
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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