HomeMy WebLinkAboutBuilding Permit Application P.1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:--�-����`) -- Permit Number:
RECEIVED
Building Permit Application SEP 2 4 2015
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
Address: a) J X1`1 '' l C. bj -rT,'br .-Luke-u- _31_k C`1 U4
Legal Description: MU � h i Is e t, Yf e e-Y LIQ
Property Tax lD#: 3 3 a P-C) - Ll4 — OCDO Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
e bac plc l;t.n it LO Wl-) a, LO 5eeP- P� '5+4ge
ya-) t4 gnbc>A 01 n& cc '55 t, r, .ii �► +fit er' n,\od-L. -T evy�LP -erD(ate 0
Loa" toe_w ' -er_AV'%C.
>Y' - � a 2` i' Yet .
itsHVa work to e,performed under this permit-c ec a appy:
A
'' Gas Tank ❑Cas Piping _Shutters Windows/boors
r]Electric i_�t Plumbing Sprinklers 11 Generator Roof
'total Sq. Ft of construction: S Ft.of First Floor:
Cost of Construction:$� �0 Q Utilities ll Sewer EJSeptic Building Height:
.£ y f� M.
a
Name Dn'y t +") t-3 t ---R- Name:__1>4 u It:) aw-)C -tt.►'
Address: 2X I yiAW`'Z"'�is i..i--1Q.tL_ - Company: _ -
City: a(-r SI +, )-z-t.C..C.O_ Mate: R_ Address: LO 5 i 1*MDrC SA'
Zip Code: Fax: City: t- E& Lkxck e- State:
Phone No, �;Lya Zip Code: 3 Fax:'7 Ma-Q 3'-I-5.51 f
E-Mail: Phone No.
Fill in fee simple Title Haider on next page{if different E-Mail: `t � - -
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
p"2
DESIGNER/ENGINEER: ,_„^Not Applicable MORTGAGE CI�MAANY: IVot 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:
1 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 th 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 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
commencin r recordi tlr Notice of Commencement
5
_Signature of Owner/Lessee/Agent Signature of ontractor/License Holder
STATE OF FLORID - STATE OF FLORIDA
COUNTY OF L} �' `� W CA-0 COUNTY OF P ,t"T ,`,f} Uic i Q
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Z>day of- So j)- 20 16by this'13 day of 20 L by
(Name of person acknowledging) (Name of person acknowledging)
{5 gnatLr2, J otary-Pubtic-State of Florida) (Signature of Notary Public-State of Florida
icna;ly g'rso nal: DR Produced Identification Per
v f% ro ;itificatian
NPet�f io
Ty
p of l ' cOUCtIARD
LIND1VMAi716 BOUCHARt! 4� ��� MMISSiON#FF12s526
Camixliss ''- 'GC7MMiS$IC�AI#FF Cori. y 2�,2oya dal'
E;CPIRES May 29,20I 8 orlCallotaryServiae,com
-
Revised 07/15/2014
REVIEWS t FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW ! REVIEW REVIEW REVIEW REVIEW REVIEW
HATE
COMPLETE
INITIALS