HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMP TED : 311 APPLICAtION TO BE ACCEPTED
Date: ' 'l Permit Number: 16 t% 4--s '
-i RECEIVED
Building Permit Application AUG 2 3 2016
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
Address:
Legal Description:
Property Tax ID #: lam,
Site Plan Name:
Project Name: i-fnn 1=-e
I
Setbacks Front Back:
Right Side: Left Side:
�Tf:Tl�hI
Lot No. / I
Block No. 'y`
-*Maw— ricof w�a`�vc cu c:r� ' VeM.4- -to cQc u . I r rJTu -c-t .-XU-r
act `� es
3lla (7i+ch. C2$-0' �9 r tup
itiona work to -be nertormed under this permit—checKa
❑HVAC Gas Tank Gas Piping
Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ l9 750
apply:
Shutters ❑ Windows/Doors
Generator �oof
S
. Ft. of First Floor: _
UtilitiesSewer Septic
l
Building Height: /0
;OWNER%LESSEE��N TC
ONl'RACTOR
Name �f�0�
Name: f
Address: -li
Company: U
City: r+ I-'>L&LQ
Stater.
Address: �3�I( 'SE_ S
►' �f
Zip Code: 3q461 Fax:
City: _ of
State: R.
/ "t gq�
Zip Code:' qq
Fax:'?7P�-7 P�
Phone No. o /
_
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page
(if different
E-Mail:
fie •� d
from the Owner listed above)
State or County L cense: C
If value of construction is 52500 or more, a KECUKutu Notice or Wrnmencemem a reyuu cu.
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 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 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.
r
x s
_ Signature of Owner/ Lessee/Agent Signature of Co ractor/License Holder
STATE OF FLORID STATE OF FLOTIAV)
COUNTY OF N amo COUNTY OF
The forgoing instru ent was a knowledged before me The forgoing instru ent was acknowledged before me
this � day of 20 J&by this day of 20 « by
400 L) C .eve
(Name of person ackno ledging) (Name of p rson acknowledging)
(Sigii5itilhe of Notary Public- Sta)e o to ida )
Personally Known OR Produced Identification .
Type of Identification Produced...-p. L- -
`0`tt®tti6o9999!®®®i®
Commission No. ��lu� ®�®�``��COAA��°°®i,®®
Revised 07/15/2014 FF87134
71� •
(Signature of Notary Public to e o
Florida )
Personally Known X— OR Produced Identification
Type of Identification Produced
......
Commission No.�13�
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