HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL A 1PLQcABLE INFO MUST BE COMPLETED FOR APPLICATION. TO BE ACCEPTED
Date:: _ �b� Permit Number: 60.
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Building Permit Application MAR 2016
Plane ng and Development Services,
Build 79 crud Code Regulation Division PERMITTING
230(, /irginfa Avenue, Fort Pierce FL 34982 Si. Lucie County, FL
Phor ==-(772) 462-1553 Fax: (772) 462-1578 Commercial Residential ;�
PERT' 11T APPLICATION FOR:
PR& OSED IMPROVEME
Addre. s:
Legal I e.
Prop& ;y
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T LOCATION: i
Site P! n Name: _
Proje<: Name:
of o.
Block No..
Setbia ks Front Back: Right Side: Lefi Side:
_ I aa
EET� ILEID DESCRIPTION OF WORK: H�72Y-ss1r
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CON: JTRUCTION INFORMATION:
c,�ma woe to a - orme un er
CivA, c
':I Gas Tank
aertric F Plumbing
;:is Piping
Sprinklers
L _I Shutte-s
0 Generi:tor
Total ' q. it of Construction: _ S , Ft, of First floor: _
Cost(:! Construction: $ _ C.]
_ Utilities: Sewer Septic
OWII'. ERR/LESSEE:
Namc::���r~ SIG I—
AddreqVr,
City:.... St
Cai9Z _L
ate:.
Zip Ci de: Fax: -.
Phone.• No. � - moo? j'y
E-Ma .
Fill in ee simple 'Title Holder on next page (if different
from t •ie owner listed above).
If value
CONTRACTOR:
QWindows/Doors
❑ Roof
Building Height:.
Name:
Company:
_ �lrij,Bmpt-
Address:
Jam? 3& A/le- s?-
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City: Al"�' -�i�it�,w
Zip Code:
P30/V Fax: i
Phone No.
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E-Mail:
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State or Count,/ License: S e r— 1.3
N.UuauuctIon cs a.z5uu or more, a RECORDED Notice of Commencement Is required.
A -to �- I �9 D
SUPF LEMENTAL.CQR)STRUCTION LIEN;.LWINFOR.MATlQf�l'
DESIC. NER/ENGINEER: - Not. Applicable
Namt-, 40irpS
Addrr: ss:
City:. Ste te•
Zip: _ ` Phone:
FEE 57 VIP+LE TITLE HOLDER: Not Applicable
Naml
Addrr: s
City:..
Zip:. _.. - _ Phone:
MORTGAGI:. COMPANY:, � Not Applicabl#
Name,
Address: — '—
City:. State:
Zip: Phone: —
BONDING COMPANY: _Not Applicabl€
Name:
Address:
City:
Zip Phone:
I certi"i that no work or installation has commenced prior to the issuance of a permit.
St. Luc: ! County makes no representation that is granting a permit will authorize the permit holder to build the subject structur
which in c'ontlict with any applicable Home Owner: Association rules, bylaws or and covenants that may restrict or prohibit s+ ch
struck. e. P lease consult with your Home Owners As ociation and review your deed for any restrictions which may apply.
In con;: deraltion of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work.
in acco dance with the approved plans, the Florida Building Codes and St. Lucie C(:,unty Amendrrie.nts:.
The fol )wing building permit applications are exempt from undergoing a fullconcurrency review: room additions,
access+ ry sti uctures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARN' ?IN1G, TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice filr
impro iern'ents to your property. A Notice of Commencement must he recorded and posted on the jobsite
befor+ the first inspection. If you intend to Obtain financing, consult with lender or an attorney before
coma encing work or recording your Notice of Commencement.
�, �1
Signat:, r of Owne►/ Agent/ Lessee
STA1': OI= FLORIDA (� �
COI.114 li'Y OF 1 J wad
The fr oing instr� t ,as a . ledged. efore me
this_dayof,�" 20�by
(Name: :)f p
n ac:knowl
ng)
r&k_
(Sign.a ure of Notary Public- State of Florida)
Persor illy Known _ OR Produced Identificatiu:n
Type c; Identification Produced
Comm >sion INo. MACMAR
Jt+�
.,+ MY CCN4,9SION #FF009ngrl
Revd ;ed 07/15/2014
REVI
DATE
CoMI
INITIA
Contractor/License Holder
STATE OF FLUB DA
COUNTY OF.,
The forgoing in.stru ieent was acknowledged before me
this,2ZAay o�%_��� 20_//,,by
(Name of person acknowledging), --
(Signature of � otary Public- State of Florida)
Personally Known --dam 011 Produced Identification
Type of Identification Produced "—
Tommission No..
ALINE L. MONSOUR
MY COMMISSION # FF242144
EXPIRES: July 23, 2019
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REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
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