HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1a /7 Permit Number:
RECEI','PD JAN 13 2016
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 IMPROVEMENT LOCATION:
Address: -/ 00 -s aM on Ar- �0 3.
Legal Description: a-c— g 7owt-r'5- 6011d0 /5 i 0[193
valid (Indru StiQ.,L i h C&*Ao � �1
Property Tax ID#: 3s —7
3: - / 0o? - 00/0- 00 0 O Lot No.
Site Plan Name: OUA, -74V!/V4s Block No.
Project Name:�7J yrrj16 Shv4few / hS1-9H
Setbacks Front Back:X Right Side: Left Side:
DETAILED DESCRIPTION OF,WORK:
1f157 11 004e, QCGOro(iO» On 74h6 h4&o4>/
�n s�41/ Ohl I-O/AGn On 7�-AC h-& 6-0d44 wi xa/oC /
[CONSTkUCTI'!O'N�"':'I"N' FORMATION:
Additional work to be Dertormed under this permit-check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $3.4 va.. 0/� Utilities:n Sewer OSeptic Building Height:
OWNER/LESSEE ,�' CONTRACTOR:
: .
Name6yrei19Cf, rihV Q Name: Ohc4 e r vQoQ(,/ Os 1
Address:Y605 57AI /27 Company (.t'VQgCId GG fi'rJA
City: /�jA6 �� State: Address:y"5/1 S6 C410614T2, -e.
Zip Code: ?j?ll� Fax: City: S;�VA✓T State:
Phone No. Zip Code: I Y91-7 Fax:
E-Mail: 0r'i h id,/4 O I Cf,iOyd, C0M Phone No. 77.2 • - d �
Fill in fee simple Title Holder on next page (if different E-Mail:6104,4 O QdVQ.iet4l u lr,c`4oe• h z
from the Owner listed above) State or County License: e0c
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPP.LEMENTAL CONSTRUCTION LIEN LAW INFORMATION.'.
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'l 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 f' t inspection. If you i tend to obtain financing, consult with lender or an attorney before.
commenc' work pr'fl!cording^r Noti of Commencement.
- s
Ignature of Owner/Lessee/Agent
S. nature of �tractor/�Uicse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF c) COUNTY OF 5-'
The forgoing instrument was acknowledged� thisefore me The forgoing.instrument was acknowledged before me
this �OdN
ay of � rf- �Zr 20 by \3 day of ZAIV� 20 \q by
(Name of person acknowledging) (Name of person acknowledging)
SO��Y 3. :fir
(Sign re.of No ar Publ&State of Florida.) (Signature of Notary. blic-State of Florida)
Personally Known dot oduc ` i e i Personally Known OR Pro uce, I nt a-tions' .
rnY P Notar Pub'c State o n a v;--"
Type of Identification Prodrrce�' rT0`� Type of Identificati�on=Pro'dicetl n GIVENS
U a My CommissionFF 122601 ' �`�'"�r��G��'% Notary Public-State of Florida .�
Commission No.� �� (.Snf� Commission No. ` y Gomm.E�ISea0 1s,2016
pts Ex /17/2018
Commission#EE 858761
n ded Through National Notary Assn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS