HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ..- br. Permit Number:
- -' RECEIVrD JAN 15 2016
Building Permit Application
Planning and'DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 "Ilk
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line W'%v�adtJ �4�
PROPOSED IMPROVEMENT LOCATION:
.Address: \V)W cle1--\.` f)r 'l
Legal Description: \ �� \ i41\11\�
Property Tax lD#: S 1 a -`�®1 (�i�7d� — l�Q� "Ll Lot No.
Site?Ian.Name: 1 Block No.
Project Name: 9AT XSA
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work toe performed under this permit-check a appy:
F1HVAC F Gas Tank Gas Piping _Shutters Windows/Doors
Electric D Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ `I10}V UO a Lf'�) Utilities: Sewer ESeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name'., Name: �-
Address: )1(Ak Saw. %tw_- n�\ c Company: CAer o
State. Address:
Zip.Code: Fax: City: PSI® State: l-
Phone No. Zip Code: Fax:
E-Mail: Phone No. J
Fill in fee simple Title Holder on next page(if different E-Mail: _rh1 SC,� - ' bN, — , ( ,)—
from the Owner listed above) State or County License: C yC
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL 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.
Inconsideration 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
.befoye. he first inspection. If you intend to obtain financing, consult with lender or an attorney before
comm ncing work o recording our Notice of Commencement.
_Signature o Owner/Lessee/Agent Sign o icense Holder
STATE OF FLORIDA ST OF FL RIDA
COUNTY OF ��f.GCu� COLIN
The forgoing instrt4rpent was acknclwledged before me The forgoing instru nt was acknowledged efore me
this day of 20 Eby this day of 20 by
(Name • person no edg�n) (Name of person acknowled ' g)
Signature of Notary Public—State of Florida) (Signature of Nota P lic-State of Florida)
Personally Known OR rsop wn ORP duced entification
\toou
Type.of Identification.Produce ti i Produced ,/A
NH Rplailmnus
Jnr coMMIsstou 0 Ba21126rt, Nor ANG f
Commission No. No aryp �A Seal
or � 10,2016 .F S P.• f;' �1t---�11f _�
'•yoc ago.• 0 C
My dam�►/ss�o� rate of pj ,!
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Revised 07/15/2014 gh 't%ona�V?7 201
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW" REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS