HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: alb, Permit Number:
- ` k0RECEI'.7D FED' 0 9"2016
ommoomw 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 u Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED.IMPROVEIVIENT:LOCATION: w
Address: Hf"rw 10014 12 O
Legal Description: SfA W,f-05 Con-00 Wr (( 01( [ Ur4 5S ) --W ?Yt1— X26 ZA
Property Tax ID#: '11-07- -CQ&4-Com'3 Lot No.
Site Plan Name: ;1I CIC4.,L Block No.
Project Name:
Setbacks Front 11✓ Back: Nl� Right SidelV Left Side: i_
DETAILED D, SCR{PTIIOON C3F WORK '
�J.410,), 2 cn� 6KrT�1116
5 17ZI
CON
STRUCTtOiV INFORMATION
Aaclitional work to be performed uner t is permit-c eCK all appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters J4 Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Constructio S Ft.of First Floor:
Cost of Construction:$ Utilities. _Sewer El Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name I,uN IN, D,C' Name:
Address: 41L'0L T` IBJ Company: �'y!/tiuri
City: SGW4-t,0s State: Address:
Zip Code: I gGJj. Fax: City: aState:�_
Phone No. Z(�� 23/� Zip Code: 7 V094 Fax:
E-Mail: Phone No. 0Oq
Fill in fee simple Title Holder on next page(if different E-Mail: /G Gr CvV. 0.
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. Q
SUPRLEMENTAL CONSTUCTIQN LIEN A
LAW INFORMTION
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: SvQ,,,,ex�, IMoc coq CL ?,C- . Name:
Address: 2W o 58,9' D< norms klot Address:
City: Ne&rwc4e-e' State: J( . City: State:
Zip: 33-lbo Phone: --ia-i 63a ` oco 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 pro erty.A Notice of Commencement must be record a posted on the jobsite
before the first insp ct' n If y u intend to obtain financing, consult ith en er r�attorney before
commenci rk r ec rd' our Notice of Commencement.
"J� Al-IL, � ( I s
_Signa ure o caner Lesse /Ag nt Sig
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �ST (Jr COUNTY OF
The for����)'ng instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�?day of �%`/� 20 //,by this �day of /=,�f3 20/�—, by
(Name of person acknowledging) (Name of person acknowledging)
(S�ignatbTe of Notary Public=State of Florida) (Signature Notary Pub/lio-State of Florida)
Personally Known / OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced Type of Identification Produced
o
"" A$9ftQMMOND Commission No. M•GAUMOND
Commission No. ;••;Nt'•lt'�r +: fSINISSIONitFF173907
:r MY COMMISSION Y FF 173907 ' EXPIRES:December 7,2018
P EXPIRES:December 7,2018 .......'
t ary n e e s �q
Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS