HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -1
Date: AN6 Permit Number: , 1 a oa3
RECEIVED FEB 10 7017
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: To Select from dropbox, click arrow at the end of line
PROPOSED IIUIPR01lEME[WT LOCATION
-,� �(,' ter^ ��,,,_ ,/
Address: &22o !3 0 g6%j //e �`ly3 J6bSA/ f G wIA114
Legal Description: 0rEAmt cA= Coriog 4-Pr 4031 Ar-,3 UNoig gag2f. 1rJ
co 4,MJr4 �fp►�CWrs C01'L 2829- Z7;c��
Property Tax ID#: 7/5'11 --f/f <Jo 31- Oo p- " Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front. I&IIA- Back: Right Side:-ALIA--Left Side:
DETAILED DESCRIPTION OE WORK
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CONSTRUCTION INFORMATION -
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itiona work to be nertormed under tispermit-check al Y:
HVAC FGas Tank F]Gas Piping _Shutters LJ Windows/Doors
Electric ❑ Plumbing 1-1 Sprinklers ElGenerator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
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Cost of Construction:$ �(),00 Utilities: _Sewer 0Septic Building Height:
OUVNEEt%LESSEE CONTRACTOR x
_ .s, .
Name Af07-#y$ �ZiN Name: /t/�GFI�Y�L �ayJr�✓�i✓
Address: GV /O(rr OG Company:
City: Ch4(6&-) State: Address: /7Zo Ni* A2�
Zip Code- 0 Fax: City: GIV41 — State: dq�-
Phone��o?7 Y15 =_1/06 9 Zip Code: 91(f Y Fax:a '97yS�
E-Mail. Phone No. 77�i'��f2-0090
Fill in fee simple Title Holder on next page(if different E-Mail: /�iGl �iLGCbDG✓JN�Y4�DlJ.Cok/f
from the Owner listed above) State or County License: Car✓/ro'6i/zz-
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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:SURPLEMENTAL CCMNSTRDCTIO:N LIEN LAIN IN00R(1lIATION.' `` x
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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:
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 OWNER:Your failure to Record a Notice of Commencement may result in y r paying twice for
improvements to your/r/et . A Notice of Commencement must be recorde a osted on the jobsite
before the first i spe ouintend to obtain financing, con t . le er r attorney before
commen on rk r our Notice of Commencem
s
Sig ature of wner/Les ee for as Agent for Owner ignature of Contract icense older
STATE OF FLORIDA / STATE OF FLORIDA i
COUNTY OF �Tlu COUNTY OF $ l�/
The fos$'ng instrurr� Jas acknowledge� efore me The forging instrum t�(vas cknowl edgedbfore me
this�day o %t'/ 20 by this��day of le 20 b
(Name of p snack a g) (Name of per on ac nowledging)
(Si ature of Not��OR
tate of Florida) Lersonally
re of Nota y.Public- at of Florid
Personally Known Produced Identification Know OR Produced IdCel,
Type of Identification Produced cation Produced
Commission No.�7 �� �' a mmission No. Ito
OHN LEE TINNEY ,,����„ JO N LEE TINNEY
•1P N�ii � PV �i
Notary Public State of Flori a ?�`� ;��; Notary Public State of Florida
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Revised 07/15/2014 p
Commission#FF 165316 :r 'oc Commission# FF 165316
��'' ���� Bonded through National Notary Assn. °%FO Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS