HomeMy WebLinkAboutT111 SIDING ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 51�1,6 Permit Number:
RECEI': MAY 0 0 ?.915
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:-V- ,N N
PROPOSED IMPROVEMENT"LOCATION:'
Address: r7L�6
Legal Description:
Property Tax ID#: V36 o <v41- G W.Vs- 5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF'WORK: µ
�2 r-1 O 1 f�?- r0 4eG-,) wQ 0 -4- r,, �' I a:-
cI �.
--CONSTRUCTIO,N INFORMATION
Additional work to be performed under this permit—check all that app y:
_HVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors .
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
2 0�
Cost of Construction: $ J 25 Utilities: —Sewer _Septic Building Height:
OUVN.ER/LESSEE .. . CONTRACTOR:
Name SSG{ S Name:
Address: I�dn� � �� Company:
City: -ItiY� Plz-11W State: Address:
Zip Code: 3'Ns—(( Fax:—,--O— City: State:
Phone NZip Code: Fax:
E-Mail:USGtJd � �� A7j-, /U23a 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.
SU,PPLEMENTA:L CONSTRUCTION LIENLAW.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 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 WNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements o your property. A Notice of Commencement must be recorded and posted on the jobsite
before the fi st inspection. If you intend to obtain financing, consult with lender or an attorney before
commerrcln yv k or recording your Notice of Commencement.
s
I_Sign atur of Owner/Lesse ent Signature of Contractor/License Holder
S OF FLORIDA STATE OF FLORIDA
COUNTY OF 't-,k- Ly C\4— COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this S• day of)IN" 20 NGby this day of 20 by
L:es S1n�
(Name of person acknow edgi ) (Name of person acknowledging)
(Signature of Notaryublic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Pro c� � _ivEN�s ersonally Known OR Produced Identification
Type of Identification Prod L b �— -stat o°rid pe of Identification Produced
�� Nuc y p-r"e�li 16
Expires Dec
rJ p: �" D EE 858761 (Seal)
Commission No. •_ +e� # 5�-'mmission No.
«z; mission °tary A
9°redThrough�Nuali°na1N y
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS