HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number
T
Building Permit Application
RECEIVED
Planning and DevelopmentServices AUG 15 2015
Building and Code Regulation Division
7300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-3553 Fax:(772)462-1578 Commercial Residential��r�
PERMIT APPLICATION FOR: To Select from dropbok, click arrow at the end of fine
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Address: r
Legal Description:
Properly Tax ID#; a /- C� -�c�d� �~ Lot No.
Site Pian Name, Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEI`AILED DFSCRIPfilO.l EDF 1 O.RK" .:
CONS':f1 tJ 3► ::tWORMAT ONA. ..
Thane war to e e rmn .. under tis permit-c ec a appy:
HVAC 13GasTank ❑Gas Piping 5hutters ❑Windows/Doors
IYElectric M Plumbing Sprinklers Venerator L-1 Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First Floor.
Cost of Construction:$ 4� 5"0, e� Utilities:0Sewer Septic Building Height
{JVMI!IV;Eirt�LESS.EE: cbNTRACTOR:
Name IMd,192 9Vf Name: t
Address: .� Company= "4 � f� 'sr• s�,�"'f,
City: State: Address: .;!z /`fit fir �•
Zip Cade: Fax: City: A-9 L Stater
Phone No. ?7a- 3 7D f Zip Code: 3 Fax:? 3.-344J'
E-Mail: Phone No.
Fill in fee simple Title Holder on neat page(if different E-Mari: il,, g Qi X21 y���-
from the Owner listed above) State or County License: . De)OC-) �.
if value of construction is$2500 or snore,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: V 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: _1/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 theermit 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 Horne 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 rev-Lew: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.
.0,
afore of owner/Agent/Lessee S!Vfature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF COU
Theforgoinginstr U ZZ& 'ncknowledged-before me The forgoing instrument was acsmowlacknowledgedbefore me
ment uja'
this day of !Z 21��by this_day of -:d-eggel-< 20 -by
(Name of person acknowledging) (Name of person acknowledging)
(Signa -Wof Notary Public-State of Florida J (Sign dMireof Notary Public-State of Florida
Personally Known .OR Produced Identification Personally Known A,— OR Produced identification
Type of Identification Produced Type of Identification Produced
JULIET LAW LIET LAW
Commission No. NO'I NOTARY PUBqlMornmission No'. F-sy�/,- CARYPUBLIC
STATE OF FL"DA
is) Fr-PARiUM NARY
OF FLORIDA
-4RMb Expires 10/2812Q16A;Wnffi#MEW=
Revised 0711512014 Expires,I0 t6
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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