HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �QA I \C. v: Permit Number:
---------------
RECEP—D DEC 16 7.016
IiZl I
9JPG�qg� JAPP on
Buildin
Planning and Development Services D
Building and Code Regulation Division BY
2300 Virginia Avenue, Fort Pierce FL 34982 St. LUCie Cour?,�/ 171
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercia — Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
I PROPOSED IMPROVEMENT LOCATION: III
Address:
Legal Description:
Property Tax ID #: 14 ow 0 00 - (.00 Lot No.
Site Plan Name: Block No.
Project Name: k �'Y\ 0 -
Setbacks Front Back: _ Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Chcunod 104tf� on Cmopq-
W to 6 1�qo
I
zbqlq_� 2Q—n A
CONSTRUCTION INFORMATION:
Additional work to b rtormed under this permit -check all apply:
E1HVAC Gas Tank E]G__ Shutters E]Windows/Doors
gElectric Plumbing []Sprinklers E]Generator D Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction:$ $34zo.(3c,
S Ft of First Floor:
InSewerElSeptic
Utilities. Building Height:
OWNER4LE SEE:
CONTRACTPR:
Name—k
QNU,4- �-U
�1 4t U
IV
Name:
-JaIlAt
I
I
Adc1ress:7:iiPoi in&'10 '(060
Co m pa
City: 'a -pleret State:
Zip Code: �iWl 61 Fax:
r-rl
Phone No.
Addres iD IN
sy:
Waf t
Cit State
Zip Code: Fax:
Z) t Vi
Phone No.—, UqQ_ DOUL)
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License: ou
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY-
Not Applicable
Name:
Address:
City:
Zip: _ Phone:
—State:
BONDING COMPANY-
—Not Applicable
Name:
Address:
City:
Zip: _ Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
build the subject structure
may restrict or prohibit such
is 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 operty. A Notice of Commencement must be recorded and posted on the jobsite
before :I ri�lf you intend to obtain financin& consult with lel&er oran attorney before
STATE OF FLORIDA V_
COUNTY OF 6460-e
The, r oing inst, ledgetrhfore me
I
day of ftr 2 by
kn( A )ez 010 1 ab
(Signature
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. "5 (Seal)
Revised 0711512014
STATE OF FLORIDA dodt
COUNTY OF
The in inst ent was ckn ledgeJ before me
A Qw
this fTdagy 20 by
(Signature of No u ic- State of Florida)
Personally Known717 OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
ZONING
REVIEW
SUPERVISOR
W
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
REVIEWS
FRONT
COUNTER
DATE
COMPLETE
INITIALS