HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / 1
Date: Permit Number:
EIVED
Building Permit Application
Planning and Development Services DEG,3 0 2015
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St.Luc' ounty, FL ._
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED f' 'PRt7VEMENT LOCATION;
Address: p
Legal Description: 79.22 t,d.N G tPe W 6rfi So_ry, r`t/c� EL 3 q 0 6
PropertyTaxlD#: 33Z�.� �C�3 '- �6 ��--D� � `' S Lot No. 7 r
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEQ AILED D�E�.SCRIPTI,®N ���F U1f0R�K:
D Q.r
o
(✓JnJ e.r` S cam.d h-cJ a�r
CONSTR{lJCT10 1'NF®R ATtON: '
Additional work to be performed under this permit-check a t at app y:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
Electric 7X Plumbing _Sprinklers —Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
d fL
Cost of Construction: $ (-(5 Utilities: —Sewer _Septic Building Height:
®U1/NER/LESS` "E; C®N_TR�CT®;R;
Name S "k 6f- Name: (A)&4W r ?6kbwcl ICS 1 45
Address: n -l"ez,,�tA 1',^'1 S 36,) Company: 1PIiIA44c
City: 26C & 12e on1 State: Address: 1616 ^J±Q:;5 A-ve-
zip Code: 3 3 L{3 ( Fax: IO Ik City: rsk-- Pie� State:rL
Phone No., Zip Code:_ `,tq g Z Fax: & A
E-Mail: Phone No 77Z-S 7 9 -2`f
Fill in fee simple Title Holder on next page (if different E-Mail WeAW LVAA��W4 116 (0 9 M .68
from the Owner listed above) State or County License C."G 14z-,6o,1#
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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�; PRLEMENT L CONSTR+IJ;CTI®N L'EN l.l�W N:FORMATIQN
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:
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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 Ihas 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 thatil 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.
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Signature of caner/Lessee/Contractor as Agent for Owner Si ture of ntractor/License Holder
STATE OF FLORID STATE OF FLORIDAc� q
COUNTY OF _ ,Q_ COUNTY OAF _1'-.il,.trL•X-r'_
The forgoing iinstri.Lment was acknowledged before me The for oing:instr ment was acknowledged before me
this day of 201'S
0 1J by this ay of TJF V_ 2QLS by
(Name of person ac owledging) (Name of pe on 4knowledging)
(Signature of Notary Public-State of Florida ) (Signa e f,Nota�ric- of Florida )
Personally Known OR.Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
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