HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST RE C IMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 ro Permit Number:
R E C E Rr''D JAN 0 7 2016
Building Permit Application
Planning and Development Services
Building and Code Regulation Divisi r
2300 Vir9lnio Avenue,Fort Pierce FL_'498.1
Phone: (772)452-1553 Fax:(77 146;'.--x578 Commercial Residential >C
PERMIT APPLICATION FOR To Select from dropbox, click arrow at the end of line
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Legal Description:
Property Tax 10 �-Saa- .aaa�_a�a --o Lot No.
Site Plan Name: �� � _� r-C,�•-fir Block No.
Project Name:
Setbacks Front Back:_ Right Side: Left Side:T
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Add itlona I work to bff rtormecl unc cr r this permit-c _ a appy:
❑HVAC Gas Tan OGasPiping _Shutters []Windows/Doors
IEElectric Plumbing OSprinklers Generator Roof
Total Sq.Ft of Construction; _ 5,ct]of First Floor:
Cost of Construction:$ (.� � Utilities: Sewer O Septic Building Height:
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Name `
,a� ,.,..,.,.�._. Name:
Address,s, �� � � _ Company:
City: ' n State: Address:
Zip Code: �. Fax: _ City: . 1 State: Y
Phone No. + Zip Code: Fa 02 d -d 703
E-Mail.• Phone No. C
Fill in fee simple Title Holder on r e}xt page(if different E-Mail: ti ?5'h n 4 G -' 1 "e ee- -1
from the Owner listed above) State or County License: +r 3U t l l
If value of construction is$2500 or rr ore,v RECORDED Notice of Commencement is required.
£000/Z000in XVd Nd £V:T 9TOZ/LO/TO
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DESIGNERANGINEER: [pct Applicable MORTGAGE COMPANY! Not Applicable
Name: Name:
Address: Address:
City: State: City: State,
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY; Not Applicable
Name: Name.
Address Address:
City: City:
Zip: Phone: Z!P: Phone:
I certify that no work or installation h s torr monced prior to the issuance of a permit.
St.Lucie County s ntat cin that is granting a permit will authorize the permit holder to build the subject structure
which isincon ictwithanyapplicable Ilomv Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure-Please consult with your Ho e Owners Association and review your deed!or 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 plan.I 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,wails,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your fait are 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 yo i intond to obtain financing,consult with lender or an attorney before
commencing work or recordinR our Notice of Commencement.
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Si trure of Owner/ gent 5fgn—ap-de- f Contra ntra se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF (""Yy COUNTY OF f u 0—
The f=olrig insttument was acknow edgec:before me The forgoing instrument was acknowledged before me
this_L.�day of MAI Qcl rNJ 20 JWby this a_day of_ 20 _L(C by
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(Name of person acknowledging) .T
Name cIrperson acknowled&84J
32 1
(Sig at of Notary Public-State OfI 1C)rida (Signat e N bli ., t2teofFlorida)
Personally Known U (SWOR&RHMILEY Personally own OR Produced Identification
(S'gnat N Obri
Known Personally own OF
Type of identification Pr *c 1,c0ww1aKxLg r-P_:NW2 Type of identification Produced
moom-3 09*mmbw 21 20A
No A
Commission Commissi
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Reviscd 07/15/2014 11XP=*0wwnbw24 2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER RE%I EW REVIEW REVIEW REVIEW REVqIEWREVIEW
DATE
COMPLETE
INITIALS
1:000/c000ln
yVd NJ VV:T 9109/LO/TO