HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'aT��s Permit Number: �51� X335
RECEP.—I 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 v �,C JLoat d
PROPOSED IMPROVEMENT LOCATION:
Address: 100L19 S Otirf{N A& 0011"olotl
Legal Description: 4;�qW IN'OS /)PT c90L1
Property Tax ID#: L���� t-) ou I"'. CGU Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
� -eLACZ 9AItc A��
CONSTRUCTION INFORMATION:
Add
itiona workto bene orme under this permit-check a appy:
��EKWAC LJ Gas Tank E]Gas Piping _Shutters a Windows/Doors
11 Electric 0 Plumbing Sprinklers 11 Generator E] Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ V U Utilities:Sewer Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name �Ji+� £1 eu&) 14y jGss�( Name: TiChAaA 110,LKA&f-
Address: (O0 J2 Company: c'Mc-Av /)/c /,)
City: I 6AC i- State: Address: G 3 3 09- 1-t<r�P l c.D n� tA)
Zip Code: 3 g Fax: City: 'I aP-r S'V LU CAL Stater
Phone No. Zip Code: Fax:
E-Mail: Phone No. J11sq
Fill in fee simple Title Holder on next page(if different E-Mail: `!2 Voow-y- 0 Cy.M e4's r, �L S
from the Owner listed above) State or County License: L_/i Cy4i(>Id ti
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL 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 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 rjpcording your Notice of Commencement.
( 17
s
_Sig ature of Owner/Lessee/Agent Signat Contr ctor/License o der
STATE OF FLORIDA STATE OF FLORIDA ,
COUNTY OF COUNTY OF S-t. t-
Thef going instrument was acknowledged before me The for oing instrument was acknowledged before me
this 1 day of e c. 20�by this �� day of Q ,20 '15 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida)'` (Signature of Notary P lic-State of Florida) "
tipl� �� ? GIVEN' �oda
Personally Known OR Produced [den �� OtF�° ��6 Personally Known s5R' r dub c uficli i.
Type of Identification Produced -S�a��o��� , Type of Identific on,E?red P Deo 16 Y
QV rtes 05" V p,Sns :o` a o; COmm. F3
15K,
Commission No. �acy Ev-Q EE •�
, Commission No. _ K comm � eal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS