HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: !'2..�� • l (_,e Permit Number:
1 V E 0
O
Building Permit Application JAN 2 5 2016
Planning and Development Services
Building and Code Regulation Division PERPJIITT
2300 Virginia Avenue,Fort Pierce FL 34982 5t. Lucie Co y, FL
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'IMPROVE'MEENT.LOCATION:
Address: �
,, ,,,n^,
Legal Description: 11
Le( fJy mn_ � , �D� OOP lit ( 4 &pf ZI
(z f n z - 352
Property Tax ID#: 3U2(.P r (o(2q GO ZI - QQQ " cD Lot No.��
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED:DESCRIPTION OF WORK:_�
�S 10A c, rr 40A Nwr /fin .1'�
CONSTRUCT.ION`INFORMATION:'
Additional work toe nertormed under tispermit-check all appy:
❑_HVAC Gas Tank ❑Gas Piping _Shutters Q indows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator WRoof
Total Sq. Ft of Construction: 12- 12- SQ S . Ft.of First Floor:
- 0z)
Cost of Construction:$ Utilities: _Sewer❑Septic Building Height:
OWNER/LESSEE: °�/ �-CONTRACTORz:
Name 'e— Name: S
Address: N 1 071 ii(l Company: F l I n
City: St UA 02, State: Address:ILOD I S S- M
Zip Code: 3llGS Z Fax: City: PQ(1 XA (k P State: Re
Phone No. ?lam- Y?.5& Zip Code: FaC7-72) 335—L355Y
E-Mail: Phone No.(-7 22) -3 0755 P
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: c732S13
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION UEN 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 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,consult with lendero an attorney before
com ork or rec r in our Notice of Commencemen
s
_Signature of Owner/Lessee ent Signature of Contracto icen a older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,:Z Z Uff.5- COUNTY OF -51"Lu CZ5
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this sbklay of !� ., 20& by thisaJ�y of 71094 114( 20 A by
?13441) .5 . A064in)
(Name of person acknowledging) (Name of person acknowledging)
(Signatur of Notary Pubic-State/of Florida) (Signature Notary Public-State Florida)
Personally Known/_Z----OR Produced Identification Personally Known oduced Identification
Type of Identification Produced Type of Identification Produced
iw
otPR� DENISE LE Y 2o�P:::4* eapy'BDENISE LEMAY
Commission No. �g 9D 90- MY COMMISSION# F�3%%ission No.6E$7d7- COMMISSION f EE 8707EXPIRES:Marchi 3,2017
Bud et No ryServices � EXPIRES:Marchi 23,201
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS