HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1_1�' 1 S Permit Number: (5 `� -d 2_1 6
RECEIVEH SEP 15.2015
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Building Permit Application t
Planning and Development Services
Building and Code Regulation Division j
2300 Virginia Avenue,Fort Pierce FL 34982 r ?
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line qr°'��
PROPOSED IMPROVEMENT LOCATION
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Address: 5,909 S/9/>'NIyoXf 44 zxle"_WC100 )%/Zx
Legal Description: LWA'i5 ZLOD 19/1k— /U;rd — 9kk I VO Lo 16 (I wP i�i//.2 Al
(o2 39-11
Property Tax ID#: 1301413-a 104 —ODt7 —q Lot No.�
Site Plan Name: _ Block No. Iilo
Project Name: /"/ry��/ 7- do DIVE S
Setbacks Front Back: Right Side: Left Side:
DETAILED.DESCRIPTION OF WORK _
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CON�STRUCTIOIVvINFORMATION:
Additiona I work oflQsTank
orme under this permit—check a appy.
1jHVAC ❑Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers q Generator Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
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Cost of Construction:$ vv Utilities: Sewer a Septic Building Height:
OWNER/LESSEE ;CONTRACTOR
Name IMTT 116 tj/wris Name: /< G
Address:_ q10 G �&SS �!�/� Company: '54"r I`"e"mG (3od If"0/
ore s
City: / YLG State: G. Address:_/ ��,AfL�iil�D�2��T '
Zip Code: Fax•. City: S L State:_Ge—
Phone No._ ` .�`1', f 3?., Zip Code: :3/14/79'S Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: !J TG
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CQNSTRUCTIQN LIEN�LAW !NF®RMATIQN
DESIGNER ENGINEER: "T Not Applicable
Name: MORTGAGE COMPANY: —Not Applicable
Name:
Address: Address: j
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:
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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 j
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments. j
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 property.A Notice of Commencement must be recorded and posted on the jobsite i
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
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Signature of Owner/Agenj Lessee Signature of ton tractor/Lic se Holder
STATE OF TATE OF FLORIDA
COUNTY OF FLORIDA��'. Ly c��-2 COUNTY OF Sic• 1-�c ,�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Ste. , 20�5 by this L�P_day of S e P,h 20_M by
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m a s k x,J d,4 n c, r I
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary P lic-State of Florida) (Signature of Notary P lic-State of Florida)
�vENs �o[�aa
Personally Known - OR Pr d Pick tai®A\ �6 Personally Known OR Pr duced Ide t'.
Type of Identification Produc !��ynUc 5,nec ,5A Type of Identification Produced L Ns
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Commission No. �p ,
-My C��[�N;o a�No�a[Y P Commission No, a[y public•����+16,6��6
ommission#onal Nota[y Pssn.
.�'`�'do.',ss!L_j'' or c� onded Zh[ �
Revised 07/15/2014 ;'•.r, '.......,
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE j
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE 1
INITIALS i
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