HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `1ad,�� Permit Number: �CoO -oa�9
RECEIVED JAN 2 01016
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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 drop box, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION;
Address: PJ (20eJ2?DV74,", ?2)T- -- J
Legal Descr' tion: � � T'w� A� �/77 "[ ��� y� yb / % ��1{�I70 'Yq/
28—N i( b .— 311�—q—e3cl)
Property Tax ID#: .5,30~ 02,&q - 00Q— (, Lot No.�'
Site Plan Name: Block No. "1
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION;OF.WORK.'t
c$1tiG- tAZW X4WIK
f A+ A
CONSTRUCTION INFORMAT.,ION
Additionalwork,to e e orme under tispermit-checka appy:
EI HVAC n ' Ei Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing Sprinklers Generator P'Roof
Total Sq. Ft of Construction: S . Ft.of First Floor: .3 0A1,noel aAs&
C7
Cost of Construction:$ utilities: _Sewer Septic Building Height:
OWNER/LESSEE: `' ;; CONTRACTOR: r
Name V/ f)hfr?-'•S Name:
Address:,311Z S. E2r,nt Ni Company: Cla !fJf h
City: 7 fi�SL 1_(L. State:Aq Address: S.- /V1
Zip Code: r2� Fax: City: �� State
Phone No. 15u' Zip Code: Fax:
E-Mail: Phone No. 33,r. 9�SD
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CC C D 3 2_52
v
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
'SURPLEMENTAL 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 thepermit 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 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, cons t with lender or an attorney before
com work or recg(pding your Notice of Commence
s
_Signature of Owner/Less / ent Signature of Contractor/L' nA Holder
STATE OF FLORIDA STATE OF FLORIDA S
COUNTY OF • L utter.•' COUNTY OF k' -
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 20 day of X&-"-• . 2016 by this ZC day of 'QM.• .20 ZL by
7BgAD-LS- f aGGA d [�Rftp S. 406ari
(Name of person acknowledging) (Name of person acknowledging)
43nAxL, A - Re�� 6ir"cL A. 2
(Signature of Notary Public-State of Florida) (Signature of Notary-Pubblic-State of Florida)
Personally Known V OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced Type of Identification Produced
°4 BpU� ESSNER
Commission No. - ", Commission No.
* MY CO 1 8 FF 211275 �.� E A.ROESSNER
EXPIRES:April 3,2019 MY COMMISSION t FF 211275
9tfOF F�O�\
uonaea i nru maget 14013ry bervices :April 3.20
Revised 07/15/2014 �� OFF�O�`O! Bonded IkuBudget Notary Servkes
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS