HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: l 1�' `o Permit Number:
ECEIV
Building Permit Application
Planning and Development Services JAN 19 2015
Building and Code Regulation Division
2300>rrginia Avenue,Fort Pierce FL 34982 "";
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Rem .
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ntial V/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION , :'
Address: 3 0-7& S 2 54'ti` St f (-t-Pit((Y, f:;&
Legal Description: �Lf'�S IBJ LO 2 3
2$L-5$ 514o E
Property Tax ID#: 14-2-3-CPO 3 "000 Z''b 00- 5 Lot No.
Site Plan Name: ` I Block No.
Project Name:0005; Il IdS
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK r
c vvIt�
1� ,clna� .-out )o 1�w heae ,
6jaw' MOM 4-14MY603a•250 Au WJ(tr MtJg1_# C�x -03�
CONSTRUCTION INFORMATION
Ad!dqiqtOhal work toe e orme under this permit-check a apply:
HVAC F]Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor.
Cost of Construction:$ S200. 00 Utilities: Sewer Septic Building Height:
OWN ER/LESSEE ,CONTRACTOR
Name Y16S Name: 0 G
Address: S07b S 254'ti` Company:
City; kf State: Address: r,'r '
Zip Code: Fax: !�)�A City:�Q(rfrP _ Statev
Phone No. 111-Ab M5 Zip Code:.3 5 ( r_ Fax:17a' ,�?37
E-Mail: Phone No.-7-7g" lu J-�L*
Fill in fee simple Title Holder on next page(if different E-Mail: bajbt 0. ht II
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 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 recording our Notice of Commencement.
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G a�' Z&4 'e�
Signature of Owner/Agent/Lessee Signature of Contractor/License Hdffer
STATE OF FLORIDA c STATE OF FLO I
COUNTY OF !: I JAN� COUNTY OF • ,
The forgoing Inst Wnent was acknowledged before me The forgoing instrument was acknowledged before me
this Iq0N day of 20 A by this_day of '-U1111,4CLE& 120-10 by
(Name of person acknowledging) (Name of person acknowle ging)
(Signature of Not Public-State of Florida) (Signature of Not Publi tate of Florida
/ )
Personally Known J OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. 42 ,ommission No. gZ$�d7'�P (Seal)
0"',:',; CHRISTINE J CONWEL CHRISTINE J CONWELL
MY COMMISSION#EE828626
Revised 07/15/2014 EXPIRES Augu21,2016 EXPIRES August 21,2016
396-0133 FloridaH ^ UA)396-0133 tan
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
. COMPLETE
INITIALS