HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE-INFO�My UST.BEOMPLE
CTED FOR APPLICATION TO BE ACCEPTED / 1
Date,: / I . / . . Permit Number:. `l /-:0�.V 0
•
RE. VE .
Building Permit Application.
Planning and'DevelopmentServices
JAN 2-8 2016
Building and Code'Regulation Division
2300:Virginia Avenue,Fort Pierce_FL 34982
Phone: (772)'462-1553 .Fax: (772)462-15.78. . ..Commercial Residential
PERMIT APPLICATION FOR:' To,Select,from dropbox; click arrow at the end of line n rrJ
PROPOSED IMPROVEMENT LOCATION: f7b 1�
Address: ` .
Legal Description: ? flV
.
Property.Tax.ID#: VL . Lot No. --
Site Plan Nam '1 - Block No
Project Name:70xC�, Ell IC)
Setbacks ..Front .: Back: Right-Side:.. Left.Side: : .
DETAILED DESCRIPTION OF WORK:
Nj
CONSTRUCTION INFORMATION:
ACIClitional worK to be performed under this permit-c.ec all appy:
HVAC : Gas Tank Gas Piping. ShuttersWindows/Doors:.
Electric. 0 Plumbing: Sprinklers Generator. Roof
TofaLSq: F.tof Construction: S . Ft:of First.Floor:
Cost,of Construction:,$' 7�, q a Utilities:
SewerSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Na&l ame::
Address: c e ompeny:
City:. �� State:.
Zip Cod Fax:. Cit State
Phone No. Q. Zip Cod Fax*
E-Mail: Phone.No. l
Fill in fee simple.Title Holder on.next-page(if different E-Mail:
from the Owneraisted above) State or County Licens [ )��l�j Io1a
If value of construction is$1500 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 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:.roomadditions;
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 fbr
improvements to your property.A Notice of Commencement must be recorded.and:posted on the jobsite
before the first inspection..lf you:intend to obtain financing, consult'-with lender:or an attorney.before,
commencing:work or recording our Notice of Commencement.
S
_Signature of Owner/Lessee/Agent n. Signature of t icense Holder
STATE OF.F A ll STATE OF:F A
COUNTY O �G�G COUNTY o� �t�Q
The.fooing instr me t was.acknowledgGcj b�fore.me The f, ongoing instr�entwasacknowled gedbefore me
this` day of 20 y this dayof� 20 by
o�Pnv P„Bz
. NICOLE OBERRENDER 0011 P„B NICOLE OBCRRr_+UDEI�
l t M OMMISSION 4 FF 112175 MY COMMIP, #FF 112175
April IoPPS P018
.(Name of perso nowledg F`o�o� BonaedThrusudgethote(services (Name of person F' Pdgi *ruBudge+ otary5ervices
ignature of Notary Public-State of Florida) /onallyKnown
of Notary Pub - of Florida
Personally Known OR; lde tification OR Produced Identification
Type.of Identification Produced J • _ ntification Produced
Commission No.- (Seal) Commission No: (Seal)
Revised 07/15/2014
REVIEWS . FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW' REVIEW
DATE:
COMPLETE.
INITIALS