HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: V; b'As Z ,
f RECER'7-D JAN 2 0 2016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Rhone:-(772)462-1553 Fax:(772)452-1578 Commercial Residential L�r
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.PROPOSED-iIM,PRCDVEMFiVT LOCAT-IO
Address. 6 �
Legal Description: 4
Property Tax ID#• / l dcJ -- Lot No. c?
Site Plan name: 0, ? �c f-s5- r ei, L Block No.
Project Name: l e t t c
Setbacks From Back: Right Side: Left Side:
DETAiLED'DESCRIPTION OF-WORK
CONSTRUCTION IN FORMAT,ION:
Additional work to (e nej orme un er this permit--.check ansahutters
pp
®HVAC LJ Gas Tank Gp ng as_Pi i a_ UvmdowsJDoors
Electric ®Plumbing Sprinklers I�l Generator Q Roof
Total Sq.Ft of Construction: y��� .Ft.of First Floor:
Cost of Construction:$__ ,�Q� Utilities: _Sewer Septic Building Height.-
CONTRACTOR:'
eight:CONTRACTOR
Name CTd Name: a' C
Address: C Company: 14- 04-C.I.-
city:
r 4-City: State: Cr Address: CO3 E
Zip Code: Fax• City: 1'f Vf C:y < State-Cs
Phone No. -- zip code:5 `f('Q—�)— Fax:
F-Mail: �/j� phone No.J(
Fill in fee simple Titie Holster on next page(if different E-Mail: crr �QU CI�,I
from the Owner listed above) State or Coun icense:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUP?LE9lffENTALE WI
�F1�3� AT1.��3_ -
DESIGNER/ENGINEER: �Not Applicable - MORTGAGE COMPANY- �Not Appricabie
Name: Name:
Address: Address:
Com: State: Cly: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY-. Not Applicable
Name: ,. Blame: —.
Address: Address:
City:
Zip: Phone: Zip Phone:
I certify that no work or installation has commenced prior to tthe issuance of a permit
St Lude Counr�ty makes no representation that is granting a permit will authortze the ermit holderto build the subject structure
which is in cor+ftict with any applicable Home Owners Association rules,bylaws or an 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 ofthis requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the appromd.plans,the Florida Building Codes and St.lure County AnzendrsentL
The following building permit applications are exempt from undergoing a full concurrency review-room additions,
accessory structures,swimming pools,fences,wafts,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your fallure to 81 rd a Notice of Commemmment may result in your paying --for
improvements to your property.A Notice of Commencement must be recorded and frosted on the Jobsite
before the first inspection.tf you intend to obtain financin&consult miith lender or an attorney before
commencing work or recording our Notice of Comrrienceme
s
_ rgnature of runerj Lessee/ en S' attar:of contractorl0cem Hol er
STATE OF FLORIDA STATE OF FLORMA =
COUNTY OF L,O c 0 4, COUNTY OF 5-V
The forgoing instrument was admowledged before me The forgoing instrument was acknowledged before me
thiszA clay of: acs�n 20 N&e by this-1110 day of ;j d.,^ 20 %G by
(Name of person acknowledging 1 (Name of person admowledging)
(Signature of Notary Public-State of Fltarid �,s- -: a T. (Signature of Not*Pubes State of Florida)
Personally Knower r3cecp " \a\cae.°t 6 Personally Known OR Pro sand Identifirifffo =`
Type of Identificatio uc i,� otaC� � ``es 85 �s Type of Identification PrI oduced L 0 S f
Commission 1�t0. -� - y ° nes °, nater °
55 ". M G Aeaf,:a.. ' ' ommiSSlon ltl0.� �s „r4<; N° �° 1 b+1X es Qe t0'61�
�.:� * e5a1. P
Revised 07/15/2014 `' ~
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