HomeMy WebLinkAboutBuilding Permit Application r K
ALL APPLICABLE INFO MUST BE COMPLETED FOR'APPLICATION TO BE ACCEPTED
Date: 1 �l Permit Number:
i fJ..01hRECEII".D JAN 0 7 2016
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 lineT_)e'�,: q
PROPOSED`IMP'kOVEMENT LOCATION.
Address:
Legal Description:
Property Tax ID#: 1_zo - I (��� — Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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k DETAILED"DESCRIPTION'OF WORK ,M ��z x ,p' '
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INFORMATION
Additional work toe nertormed under this permit—c ec_a-11 im appy:
HVAC Gas Tank E]Gas Piping 1:1Shutters Windows/Doors
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Electric El Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Litt Cost of Construction:$ UtilitiesllSewer Septic Building Height:
OWNER/LESSEE ; ' ,CONTRACTOR: q h
Name Name:
Address: Ll Company: ,,
City: State:-B Address: Q7 A� CL..0 C
Zip Code: Fax: City: VJ(fvu_ Stater
Phone No. Zip Code: ,3L_r1S Fax: Z- (, (&S
E-Mail: Phone N -7212 _ Le I- R21 Z-9
Fill in fee simple Title Holder on next page(if different E-Mail:. ( Q S wn' I Q n, ,q od . 6>,M
from the Owner listed above) State or County Licenser
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION 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: TNot 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 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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_Signatur o caner/Lessee/Agent Signa of Contractor/Li nse Holder
STATE OF FLORIDAl I STATE OF FLORIDA I
COUNTY OF I � ( l 9L COUNTY OF (�( ,�( K
The f r oing inst ment was acknowledged before me The forgoing instr ment was acknowledged before me
this ay of t,n 0, 20 nby thi day of. '1 i V 20 V�_D by
(Name of person acknowledging) (Name of person acknowledging)
Fy"'a M 0, C��" EcZolo- ffiJL4UW-?__
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. fission No[l \ 5 I
,�a,�►��"�•,,�,,� BRENDA MARTINS .N,,,�p,, BRENDA MARTINEZ
ltsl�e of 1 a °��r' ,� State—F
• •? Commission I FF 231565 Commission#FF 231565
Revised 07/15/2014 %� �;= M Comm.Expires May 31,2019 �e;�My Comm.Expires May 31,2 9
�iFOF Fl •' Bonded through National Notary Assn •,,,,,,,,a Bonded mrao National Notary
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