HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: I 115 Permit Number: Sd 1- d dy
RECEIVILM SEP 02 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 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVE3M,L,NT�LOC/�TION ' t F h r x }
Address:51 -71 1 --c( Ryn �b r, 3F
Legal Description:
f
Property Tax ID#: 1���' " 60,30 '- 600 � 6 Lot No.
Site Plan Name: Block No.
Project Name: - �O� 1Y�kn► �(�ISS
Setbacks Front Back: Right Side: Left Side:
DETAILED4DESCRIPTION OF WORK u -
�-nS��
Additional work to b e performed under t ispermit-check all that ap y:
HVAC Gas Tank Gas Piping _Shutters Windows Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction:
p�� 11 SFt. of First Floor:
Cost of Construction:$ 1 S�-t 0 UtilitiesIn Sewer 0Septic Building Height:
01NNER/LESSEE - t CONTRACTOR s
Name L (�S' S Ow Q'� Name Qa
Address:ST?-) .P( K Vn Dr- Company:
City: -P�� (e Stater Address:
&
S �merCC 19ve
Zip Code: ' (L�_( Fax: City: Stater
Phone No. T� 2 's q � _]I Oz Zip Code:5 2- Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: ( tf
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
09/03/2015 08:38 7725673674 FLORIDA SHUTTERS PAGE 01/01
D-ESIGNER/ENGINVER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: 7Address:
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.Luclecoun makes ro representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conlyfictwith.any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consull with your Horne Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,1 do hereby agree that 1 will,in all respects,perform the work
in accordance with the i pproved plans,the Florida Building Codes and St.Lucie County Amendments,
The following building permit applictitions are exempt from undergoing a full concurrency review.,room additions,
accessory structures,s%N imming 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 cir recording your Notice of Commencement.
Sign`aturaf Owner/Agent/Lessee NgKa-ture of Contractor/License Holder,
STATE OF FLORIDA,� STATE OJEFLORT11,
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COUNTYOF ir�
Y 00 _ yk
The f ingins%ntwas acknowledGed efor e The.for�rinstrun)pnt w a nowledged befor
to X dav )
thisd 20 acknowledged
this day of 2c)_M,>by
day of
(Name of person acknimledging) (Name of person acknowledging)
(Signature of Notary Fuhlic-State oLF[o (Signa ffK-if
stat
fLIZABETH EVAIIIS
MbOn
Personally Know Pe Rdft-:,R*tft ZON(flqhhot
or Notary public- t, Typ wV vvm.tJeq
•Type of Identific .d
commi5slan
MY comm.rApire's JWW pill EE 180951
cominlo%J EE 18057 Ca
commission No.f —- mission o.
Revised 07/1512014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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