HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE`INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2L \ `rD Permit Number: 1'�a'G
`ter�. � =� RECEP,'_"D FEB 0 9 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
r
PROPO5EDlMI'fOUMEIVT LOCATION ,
Address: ��
Legal Description: ('0 < S h) P
(rO&Pt% ,3A)) "a 3s-g2 - ria)
Property Tax ID#: 13 I.?L -X00 -00/S- 000 - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED.DES IPTlC3> O`ll"W'aRK fi
P A U-- on S i✓t) 3 c-,r.-Yz olc'N WV1,
A,OVDI.A ,Se, ,v: )lex?
FTi
CONSTRIXCTIlNEORMATION
Additional work toa er orme under this permit-check a appy:
HVAC E]Gas Tank ❑Gas Piping _Shutters windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ ��� /.3,9 Utilities:CnSewer[]Septic Building Height:
OWNERjLESSEE. � CON�'RA@TOR
#bra . „�.4,,,, ,L•d.. ?x Y:- 2 .t5^ae ¢ , r,5; 5'x „=,y v ,a... 3}E
Name P�Leir �t C��„a agizI Name: 11 1 Li1,, "I-,)
Address: 5'001 'Re.4J Company: Q.Wo.�'_
City:. FV(- U',au- State: Fc- Address: )4MA hyo
Zip Code:-24gS_( Fax: City: Vz"" 3?�o"t J State:
Phone No. I z) J-�(,?/ Zip Code: 3a00 Fax:
E-Mail: Phone No. ( 1 n _� I/01- 1115-0I
Fill in fee simple Title Holder on next page(if different E-Mail: ;.n�'o oZocrs ovclrw:�ie�c � "
from the Owner listed above) State or County License: C�C15�ZOPOO
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
5U4PPL�MIVTII:yCON5TRUCTI0N LIEN LAVV INFr7RIVIATI�Nr '
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 lender or an attorney before
commencing work or recording our Notice of Commencement.
s
_Sig at a of Owner/Lessee/Agent Signatures Contractor/License Holder
STATE OF FLORIDA n STATE OF FLORIDA
COUNTY OF COUNTYOF ave ,Li✓-�/
The forgoing instrument was acknowledged before me The forgoing instr ment was acknowledged before me
this day of �!ye 20 j�by this It day ofy`n 20 &_by
i
(Name of person acknowledging) (Name of person acknowledging)
- 6�
(Signature of Notary
Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known // uc�`��tfPc��i I�RUE Personally Known OR Produced Identification
Type of Identification Prod NOTAR _ Type of Identification Produced
Commission No.��/� c�",rurd�ITF192675 Commission No.FpPi� 7S ��QQOT YPUBLIC
_E�x(p�ir�eas 1/26/2019 A. ST1OF FLORIDA
Cmm#FF192675
Expkm 126120119
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER , : REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMP LETE
INITIALS