HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE I
Date:lrw
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APPLICATION TO BE ACCEF _
Permit Number. 51 oi- d
RECEIV ED DEC 2 2 2015
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
PERMIT APPLICATION FOR: Sign
D.IMPROVEMENT
Address:
Legal Description:
SCANNED
BY
St. Lucie County
Commercial ✓ Residential
PropertyTax ID #: 4096 - 034-S Lot No.
Site Plan Name: Block No.
Project Name: CV ia;7& QtL 4L �lr�
Setbacks Front 3 f Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
`NSTRUCTION INFORMATION:
AadiflonalworKto lie performed under tispermi
0HVAC 1:1 Gas Tank ❑Gas Piping
gElectric 1:1 Plumbing Sprinklers
L ishutters ❑Windows/Doors
1iGenerator Roof
Total Sq. Ft of Construction: 5 S Ft. of First Floor:
00 Cost of Construction: $ 61 Q�@Utilities:Sewer Septic
Building Height:
H
OWNER/LESSEE:
CONTRACTOR:
Name Q.SerY�
Name: c�cicdi2
Company J/i i /;
li7�2✓tQ.
2oa 6"Qns kke_
_
Address:1BD fY(trj/C�i/J
City:
Zip Code: 33 Co O e2 Fax:
Phone No.
Address:300/ &J•
r ranao`g__
City: % J State:
Zip Code: 311&aq Fax:Q3-3?&-.245(#
Phone No. T13- 3VIa-
E-Mail:
Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
E-Mail:7Credei/�_..�SA.
GOM
State or County License:
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-- -- v cwuirualon is: zZwu or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL
LIEN LAW INFORMATION:
Name: _
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: ✓Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: ✓Not Applicable
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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 your Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
STATE OF FLORID�4 STATE OF FLOR��Ig�A / /
COUNTY OF COUNTYOF 7����SbO/L7lL EA
The forgoing instrument was acknowledged before me
this&Sday of _/ f� 20/4— by
ame of person
The forgoing instrum nt was acknowledged before me
this) day of yLl i?e, 20 LS_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida) (Signature o- otary Public- State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014
MY CG.Y,—'&1&I0 EE161433
EXPIRES: IM TM, 19. 2016
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Commission No. �w QssloN tlEeI6I41i
qq� �ES:J®u�y l9, ml4
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION :
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
.A
INITIALS
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