HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o Permit Number:
9r RECEIVE®
Building Permit Application FEB 12 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 line
PROPOSED INIPROVEME,fVT LO:CATIQN
Address: 10044 S OCEnrJ TV- 1103 , _0456-4 &+cel
Legal Description:�iR WINQS CUvocp 'A-v27' 1103 ((7r2 9142--00-7i ;XoZ-107
Property Tax ID#: diroZ -gp y- 00eg"(-jp-4 Lot No.
Site Plan Name: _ �RC)AlV le-14 o Block No.
Project Name:—
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Setbacks Front A' Back: Right Side: N Left Side:
DETAILED DESCRIPTION OF WORK `t
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CONSTRUCTION INFORM�ATIO(V
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Additionalworkto e e orme under-t is permit-c eck all appy:
HVAC Gas Tank []Gas Piping In Shutters windows/Doors
Electric 0 Plumbing Sprinklers ElGenerator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction:$ 7$00"_ Utilities:0_Sewer 0 Septic Building Height:
OWNER/LE5SEE CONTRACTt?R
r
Name iA l G1Mb Name:
Address:/Obey S DQ91t� 7�L //03 Company: 72%,5E1J T61cl aI411,/YL01
City: :T,% V &.Wlty State: F` Address:17U 11/10) y
Zip Code: 341W7 Fax: City: fl/ State:
Phone No. Zip Code: Fax: ''Z'97y
E-Mail: 1^Tg. /l G/!Vb e6Af44L .C.oM Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: /1•J�G/ .L ,r�w�yl��r�U,C�H
from the Owner listed above) State or County License: zn(9!;aZ
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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Ssl1pPLEMEN fAL CONSTRUCTION UEfU LAM/ INFRMATIDN. 10-
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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:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Y r fai re to Record a Notice of Commencement may result in your paying twice for
improvements to your op . A Notice of Commencement must be recorded a p sted on the jobsite
before the first inspe on ou intend to obtain financing, consult wit der ttorney before
commen ' rk o re r in our N tice of Commencement.
s
gn re of Owner/Less a Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF -S7— 1,L2 /t
The forgo'ng instrument was acknowledged before me The forgoing instrument was acknowledged before me
this/Lay of f=�,8 20/f2by this/z'�6ay of 20 Z�L by
(Name of person acknowledging) (Name of person acknowledging)
(Signature o otary Public-State of Florida) (Signa f-Notary Pubic=State of Florida)
Personally Known_�OR Produced Identification Personally Known r/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ,••'tip+"yam., ANNK MOND Commission No. ., D
+ ;:`MY COMMISS #FF 173907 ,;q: `,—
ANN M.
<€ EXPIRES:December 1,2018 _+; :. MY COMMISSION#FF 173907
,.
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Rf 14 Bonded Thm Notary Public Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW' REVIEW
DATE
COMPLETE
INITIALS