HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 I'S I C, Permit Number:
RECEIL' 7D MAY 0 5 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: D c` JAW a
PRO INED INPRO IVIt, L(3CAT �igi FIRM=1104
Address: 32D Lq B cf e> na U .1-a h r Par-4- 5+. 4 o cie-, L 3 y.:F.-oZ
Legal Description: A
Property Tax ID#: 3I aZ� —�(ro y f 6 1 7 yQD a — 7 Lot No. 17y'
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Df�TAI'LE'D DE�SGR!(PTION QF U1hORK - -
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C®`STRIJCTION I'N'F®R11/IATt
Additional work to be pertormed under this permit—check al I that appy:
—Mechanical _Gas Tank —Gas Piping —Shutters _Windows/Doors
Electric —Plumbing _Sprinklers —Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$0 , a n Utilities: Sewer Septic Building Height:
OU1lNER/ ESS , : C®;NTRACT®R;
Name v s V- aZ/t�o- S o Zig Name:
Address:(oK Vi 64 r(e, /Q`0-CCompany:
11
City: r be State: ►9JA'.Address:
Zip Code: 6 (3.3 r Fax: City: State:
Phone No._9 7 'K— a b a b Zip Code: Fax:
E-Mail:7—\fL71, ,i a 6b , yrs L,11 Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Win
S�l1PPLEMWffAI_CONST LAff@ �I IU SUV II FGIRM�►TIQ;.„
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen room$and accessory uses to another non-rbsidential 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.
Signature of Owner/Le ee/ ontractor as Agent,for Owner *Signature of Contractor/License Holder: i _�`
STATE OF FLORIDA STATE OF FLORIDA d r
COUNTY OF`� �r. L V c COUNTY OF
The fsrgoing instrument was acknowled eAbefore me The forgoing instrument was acknowledged before me
this 7 day of Vv'so,v , 20by this day of 20_ by
V,y.d-W,alS L 4Z f
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu c-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identificati36,
Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced �t a L x O�P�Np G�VProduced
Skat
Commission No. `l° '0 Nota(YS1�a10pice5Commission No. (Seal)
.`�.
REVIEWS FRONT "" fi SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014