HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �dr`6 Permit Number: IG 4 1 - 36 y
RECEIVED JAN 2 6 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: S A G
Legal Description: 3 3 / -Q.f' lez- S Glrr� l s
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Property Tax I D#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK ,
CONSTRUCTION INFORMATION: ,
Additional work to be performed
a under this permit—check all tha appy:
HVAC Gas Tank Das Piping _Shutters ❑Windows/Doors
11 Electric �Plumbing []Sprinklers E Generator Roof
Total Sq.Ft of Construction: WX Sq. Ft.of First Floor: Q�
Cost of Construction:$ l{�t� Utilities: Sewer F]Septic Building Height:
OUVNER/>,LESSEE CONTRACTOR
Name Name: f�a
Address: &4 at Company:TO- r/l' L' R
City: State: Address: 13' r
Zip Code: 3VI Fax: City: Lrr Stater
Phone No. Zip Code: L Fax:=Z-31/3- 230
E-Mail: Phone No. -7 70- 1777a
Fill in fee simple Title Holder on next page if different E-Mail: i fie., f i:j24from the Owner listed above) State or County License: -s 4y5-3
19
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 TITLEHOLDER: _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, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
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s
_signature of er/Lessee/ Signature of Cont r/Lice se H
STATE OF FLORIDA /� STATE OF FLORIDA
COUNTY OF `)a,,"I L t,Q P COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged/before me
this 2-day of 20 La/by this day of J
20 &/ by
--/4G6�'k 1 1741A��
(Name of person acknowledgin (Name of persona edging)
(Signature of No Pub' State of Florida) (Signa a of ota Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identifica on Produced
Commission No. (Z2. (Seal) Commission No. (Seal)
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Revised 07/15/2014
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REVIEWS FRONT ZONING = SII RVISOR •:111LANS VEGETATION SEA ••1 s 6Rt E
COUNTER REVIEW = REVIERFTEW REVIEW RE lE1N 2:2 _
DATE •�. -1 4n A14
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