HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date-.\Q,)�e. Permit Number:
I A . \(�
111111111k
0" RECEI%"-:D DEC 16 2016
Bu i Id ingzRJqfflKqBApP1 icatim)
Planning and Development Services 13Y
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 it. Lucie County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Sign
PROPOSED IMPROVEMENT LOCATION:
Address: 76 o I Indirio Eood A. Puree , Pbfidm Z061
Legal Description:
Property Tax ID #:
— oof)l - Div) -
Lot No.
Site Plan Name: Block No.
Project Name: 12,ackd- �mfl
Setbacks Front Back: _ Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: III
�' �1 (L a 'A ( bf bm a (\ E Y� � �i f') 1 ) 10 n '� I A -
CONSTRUCTION INFORMATION:
ACIClitional worK to De nerformed under this permit — c eck all apply:
11HVA11 D Gas Tank E]Gas Piping InShutters OWindows/Doors
11 Electric El Plumbing []Sprinklers 11 Generator D Roof = Roof pitch
Total Sq. Ft of Construction: S' Ft of First Floor; —
Cost of Construction:$ L� O'bO % 0 0 Utilities: Sewer 0 Septic
Building Height:
OWNERAESSEE: In, -
4- 1 1 .
CONTRACTOR:
Name "Utu
L'�A
-
fA -1 uofu
Name: J1011
Jairlip—
Address: I
M I
Md
I, 10 ZOO *1
Company: tAoIr-hin §IqA6
Ix.
City: State:
Zip Code: Fax:
Phone No.
Address: 9_40 00 -1111b
Rffnri�
Cit : b4i aml —
Zip Code: bblLfl Fax: m6-
PhoneNo. bl)5,104 - D11211611
State:-P—L
(94 4 - DLIU5
E-Mail:—
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: I Jo 0 mrhasivin
State or Count y License: ujulp
I '34*Q a U
0 iJ 11
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
. N.
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I)ESIGNER/ENGINEIER: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: —Not Applicable
Name:
Address;
City:
Zip: _ Phone:
I certifythat no work or installation has commenced prior to the issuance of a permit.
3I.LUciet-Oun MaKes no representation that is granting a ermit will authorize the ermit holder to build the subject structure
which is in conWict with any applicable Home Owners Assoclation rules, bylaws or an9covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions %4hich 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 y ur rogrty. A Notice of Commencement must be recorded and posted on the jobsite
0 1
before the first I n f you intend to obtain financing, consult with lender or an attorney before
I
commer Ee �4clina vour Notice of Cnmrnpnrpmpnt
ZlgnalUre Or uwner/Less 7, mractor as Agent tor Owner
STATE OF FLORIDA
COUNTYOF
The f Ing inst: ledg before me
IT dayof.tm %rby
this r or
Anfo I u) ad o
'Name of person ackn 16dging) I
Person -ally Known V� OR Produced Identification
Type of identification Produced
Commission No., J�v 07 (Seal)
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF_
The fo Ing ins was ackqov�leclged before me
of !��2
this day ofru*"/1V/, 20 /Oby
'dag
(Name of person acknowledging)
(Signature of akfoli State of Florida
wn
Personal Zno 7
OR Produced Identification
Type of Identification Produced
Commission No. /K R 7/5'59 (Seal)
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