HomeMy WebLinkAboutBuilding Permit Application(Fields.Code Permit Doc Type) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _ f�
Date: Permit Number: tt 1sC79 `C/
Building Permit Application
Planning and Development Services SEP 0 12015
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982p�
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resident' '-r,
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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PROPOSEDINIPRIIEMENTLQCQTION �� �,; � ; ° i' w, r ( x =
Address: �''�� �.Lt���%� i,}C� .Lv>.-,• `�, � `�
Legal Description: �� � ",r2. s ,r Z. •1 -
Property Tax ID#: t 1�,�Lj -�% U t'1U'f)"j"(Ji✓'Z'-S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILEb
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CONST REICTLON tNF�QR(U�A'i ISN sy +;, ;;h 1 J i r� s syn i� f5f 1( Y P p t
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Additional work toe performed under this permit-c ec a apply:
HVAC []Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 12"Plumbing Sprinklers a Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ `? Utilities:'nSewer Septic Building Height:
YCONTRaGTOR,
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NameLp't, D j
,.:o' '4h'i -' UVG1'1j_ Name: V�Vh
Address: % '' ` i tt Company:
_ 31City: State: Address: VN 0 -
Zip Code: 3,1 '�S Fax: City: QnA S' .Lv"E-Xt Stater
Phone No. Zip Code: 34599 Fax:11L-8
E-Mail: Phone No. 711-V 1—01411
Fill in fee simple Title Holder on next page(if different.. E-Mail:
from the Owner listed above) State or County License: C�L �tL
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPP�aEjVfEN�fA�6C�NSTRUCTIQNf�:f���l�l.A�11!„>•NFORIU.�;I��'lOjli, r ,n, ., a, � r R �
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
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 propertjNotice of Commencement must be recorded and posted on the jobsite
before the first inspection. If ou'intend to obtain financing, consult with lender a attorney before
comm ''in ork or rec our Notice of Commencemen „ //`
Signat`ie ofOw er Agen ,lessee Signature of Contractor/Ccense HolderY
STATE OF FLORIDA STATE OF FLORIDA J _ t
COUNTY OF 1 ��”-v' COUNTY OF '7, =
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this.. (( day of ,�Cu1� 20 1. by this 3 dayy of � 20-16 by
(Name of person acknowledging) (Name of person acknowledging)
{Signature of(Motary Public-State of Florida ) (signature of rotary Public-State of Florida)
Personally Known OR Produced Identification Personally Known " F l OR Produced Identification
Type of Identification Produced Type of Identification Produced
'• B ., BY TALBOT
Commission No. Y TAL®�T Commission No. .,
MCOiNEE161693
MY COMMt$S10N#EE181893 �.•.: Y MISSION#,�t
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FiXPIRES May ft 2016
Revised 07/15/201 F16rW4Nftry3ftNf`a.c&n
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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