HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO(MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �
Date: 1�� �1`r Permit Number: /(_0 �G C)/0
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RECEIVED
Building Permit Application FEB m 2 2016
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 linee�
PRCIP�,OSED IfM'PR®aV/iE1UI�ENT�OCATI�ON: ii
Address: tl�JO (0 GC�c_tA l no, Nye �7—y, ��C2- C—L 3LItg5l
Legal Description:
Property Tax ID#: 1301- 611 — 0277-7 — DO b— S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE�TQ�lLED DESCRaIpTIO�N:Q'F `'®RK:
�L{Dr-r- e)P ZIP- -TUI 6.(u,;L2r�2,_J
CONSTRUCT,I®N lNf®R[1J�IA1 I:ON: ,`
Additional work to be erformed under tispermit—check all appy:
HVAC Gas Tank E]Gas Piping _Shutters O Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ ZY2 — Utilities:Sewer Septic Building Height:
O1NNEft/LE�SS'EE: CTRACTOR ' r
>.s
Name O 1.1 Or'rts � Name: DQ_nreIl�A
I ' CQ2�E�k
Address:���d� C0AL-4 /"�1/� Company: &Zgc01' 5�6dI o LGG
City:'� StateF Address: 12-11 SW Ander pt L 61-
Zip Code: Fax: City: State:
Phone No. ��Z" �rj Z Zip Code: 3�l!53 Fax:
E-Mail: Phone No. 7229 6_30— 2606-
Fill
6bSFill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: C c-C
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SIJ,PPLEM,ENT�i4L CONSTRAIJfION 1EN�W IIVFQnRM�TI®N ,
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
commenr,ing work or recording our Notice of Commencement.
_Signatu of wner/Lessee/Agent Signature on ractor/License Holder
STATE OF ORID� j STATE RIDA
COUNTY OF Ji�- �,(L e COUNTY OF-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this__t_day of 201(,2--by this--L day of 7V49 20/( __by
(Name of person acknowledging) erson acTnowfiedgir}gl`
(Signature of No orida) (Signature of Notary Public- a e orida-)
Personally Known OR Produced Identifications Personally Known OR Produced Identification 1�
Type of Identification Produced 7—z-- '-t)"0'1r1U7SType of Identification Produced F-
COLLEEN DEM,RS LL EN DEMERS
Commission No. lgRY PUBLIC Commission No.
STATE OF FLORIDA Y PUBLIC
_STATE OF FLORIDA
L;Omffw 1-1-065980
Expires 1012412017 a
Revised 07/15/2014 �� Expires 10124/2017
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS