HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO hPL�IST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date.- SCANNED Permit Number:
I,� BY 1 alr-D
St. Lucie County
130ding Permit Application APR 2 9 2016
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 -
Phone: (772),462-15S3 Fax: (772) 462-157R Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address
Property Tax lD #* Lot No.
Site Plan Name' � �� Block No.
Project; [damp.
Setbacks. Frorri- _- Back: - Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
CONSTRUCTION INFORMATION;
❑HVAC -E Gas Tank' ❑Gas Piping ll❑��ll Shutters ❑ Windows/Doors
❑`Electric El Plumbing ❑Sprinklers Generator ❑Roof
Total Sq. Ft.of Constiuction: • S Ft, of First Floor:
Cost of Construction: $ L2 U 0-Q06l1n J utilities:Sewer ❑Septic . Building Height:
I.OWNER'/LESSFE
Ram -, \
CONTRACTOR:
Name
el pkl `
Address:,
Company:
-
City: State
P-_ '--
1 tip Code_ F-ax:�_
Phone No. '
Address: j�
l 0/1
QSSI�T
City: state: ��
Zip Code:
Phone No. LI ,L=1)
_
Fill in fac ,iracp p'i•1fiJc I J?dr r citt next page (if different
from tlu,. fYutr 'r Hs:..d 96 ove)
E-Ma*YP Phi i%l0 (9�7Pc ✓1�� Iu•
State or County'License:
U U
If.'aftle of consVra-tib; a Is,$;• 500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION uE*WXi,V lbwTIQN:
MNGINEER: licable.
DESIGNT MORTGAGE COMPANY: NotApplicable
wamek/ &12=Q . .
Name:
Acldresiv—() Address:
City:. .,l) —Statk"' City: state:
Zip: Phone"i Zip: pAjone:.'
'FEE SIMPLE TITLE HOLDER:. otAppIIc66Ie'""'0'
ING COMPAI1Y,—N6t Applicable,
Name:
N6e
Address:
(1h
Address:
dir-
City:
Zip: phone:
A Phone'
I certify that no work or Installation has c�mrrtericdcf p'ridrEo Ylid )'iSal ancebfpperrni.,.
St. Lucie Count makes no representation that is granting a e I rmitwillaut cirizethe ermit holder to build the subject str turd,
Is In Hoffie Owners AssocFation rules,'b$ ws or ankcovenants.that may restrict or problitt Such
which co 1xict with any applicable
structure. Please consult with your Home Pwriers Asso.clation and reviewyciurdeed-for any restrictions which may apply.
In consideration of the grbnting of this requested -permit, I do fi&eby agree that I Will in alf respects, perform the work
in accordance with the approved plqris, the Florida Building Code; and St. Lucie county AmendInents,
The following building permit 8ppliCati(30"are exempt from undergoing a full concurrency review: room additions,
accessory structuresi swirriming pools, fences, walls, signs, screen room sand accessory uses toanoth-& 06h4esidential use
WARNING TO OWNER:. Your fallure(o Record.a Notli:6'of Commencement may result In your paying twice for
improvements to VOLIJ- property. A ffotice of COmmiencement. must-bp.rec-orded and posted on the jobsite
trid
before the first Inspection, to obt 'In financin&-cortsult with tender or an attorney before
commencing work or recording you'r Notice of'Viommianceme6t.
S
rbill re of owner/Lessee/Agent
SlIgnp! ContractaY/License Holder
rEOF
ATE OF FLORIDA RIDA
COUNTY OF A -)a 1-r v
96 FLORIDA
CQUIXITYOF�-- qp-y
U
The forgoing In-st ument was; acknowledged -before me
this day of 26 11l;2by
.
rri Theforaoing linstruen was acknowledged before me
il day of 20 J_k by
rl
�a-w of person acknowledyng) -
7�e�f pArson acknowledging)
I E) 0 o
(Signature of Notary Public- Sta Fiona)
(Signature of Notary Public-stateldifylorlda
PeisonallyKnown 141' OR.Producedilentificatio
Personal(yKnown OR Procluded Identificatia,ft—L-
Type of Identification Produce
lVpe o(Identificat an Pioduced
Commission Nov 5b ,a. e
�ommission No.
LLE
IU507
Ing$ Dacembbi92,
EKPIIleg Deoa
Revised 07115/2014 .
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-2018 a Flo a,
.,REVIEWS FRONT- -ZONINCA( SUPERV(' SOR"
PIANS EGETATIOq .5CA.TURTLE MANGRON E
COUNTER REVIEVtF)
'400itw' REVIEW EX �I6V
di 31
COMPLETE
INITIALS
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