HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 11 Permit Number:
RECEI".-D JAN 112017
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 1( Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
RROPOSt6,WPROIIEMEiV1" LOCATION r „
�
Address: 10&00 5 QGe717-'/ ig //l p -JrFN567V &-AC4
Legal Description: CX&-)%i A 9uVr41- 4-0yynb fr__ (/W iT II I o A-,IVr] UN Di V
<P*YZr /IV GVMM OAJ 6&6714 E7✓TS Clorz 9 I-7? — 2 `4)
Property Tax ID#: q SI I - S)1- o I I-i —ocx)— I Lot No.
Site Plan Name: 0g-yA'0J Block No.
Project Name: 1z4i�rJ
Setbacks Front gIA- Back: N lAr Right Side: IJ A- Left Side: N A,
DETAILED DESCRIPTION OF WORK a Y
�CiZ _ EN T—
AIL
NON-Sitil�gc�t�F.,f'/S�T/N6 SA47BZ,s
CONSTRUCTION IN'FORMAI'IOIV `' f
.,..o..y ., .. w,� ...,.,,_. K.<•, s . ,.,, J >. a. e,n �i,tF 4zSo, � -�, sa § �y�' a�azg �' ,. ���.�
�$ c
Additional work to be ertormed under t is permit check �a � � FV_1 p - a apply:
�HVAC Gas Tank In
❑Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
of
Cost of Construction:$ Utilities:0Sewer[]Septic Building Height:
0.1NNER/1ESS3EEr3 �r `< ' gC0'NTRACTC3R
Name �gN l ^(, T I M OT_t'-f f AILI Name. — 6211� ^/ l
Address: IJ 9 '7 CgG!ISf►a2Z t4i6 20 Company: /7ZU 4&/ Jq 27.9Z/�4'L �T
City: WWIT7EWAu_ State: AAS Address•
Zip Code:, t/9 K(o ( Fax: City: /7ZU AtAl tate: F
Phone No: d Zip Code: N-ggg Fax: 6 Z-S'7Cl f
E-Mail: TI M 1p T�&V41 6, WS Phone No. 9 Z-O
Fill in fee.simple Title Holder on next page (if different E-Mail: 1141Gr -XJ i/ Al cy>�
from the Owner listed above) State or County License:�'�f_ lno q 14
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL CONSTRUCTION Llt~N LAW INt3RMATI�N
.z:
r ..� � �.. ., � .-. p,.r,. x.pp_ � MORTGAGES
17
DESIGNER ENGINEER: _Not Applicable 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 OW R: our fai re to Record a Notice of Commencement may s tin your paying twice for
impro m nts to ur r er . A Notice of Commencement must eco d osted on the jobsite
bef e the f' st i pe I I ou intend to obtain financing h e er or an a ney before
c men ' w rk r o in our Notice of Comme ment.
s
Signature of Own er/Lessee/Contrac �ras A�Owner"' Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORA
COUNTY OF COUNTY OF
The forget instrument was acknowledged before me The forgoing instrument was acknowledged before me
this/�may of ��J� 20/�iy thi�/JZy of 20 fZ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature-anvatary Public-Mate or rioriaa i (Signature o o &Cyy Public-State of Florida)
Personally Known y,-o"' OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. I Commission No. (Seal)
a•t Y's ANN M.DAUMOND ;=q+�"Y'%Q;•, ANN M.GAUMOND
�` ro EXPIRES:December 7 2018 �,., *` EXPIRES:December 7,2018
Revised 07/15/201 '%a,';t4 Bonded Thru Notary Public Underwriters %;pf ° Bonded Thru Notary Puhl c Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
I