HomeMy WebLinkAboutBuilding Permit Application 3
ALL APPUCABL)E(INFO/MUST SE COMPLETED FOR APPLICAT bN TO BE ACCEPTED
Date: . % �/ ' / Permit Number: �J�a �,
a
Building Permit application FEB 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 Comm6rcial Residential
PERMIT APPLICATION FOR: To Select from dropbpx, click arrow at the end of line
Address:
Legal Description: !
G N LV yN
Property Tax ID#: ���y 1 �}(3"L`� UGd" Lot No.�_
Site Plan Name: S�i�,� Block No.
Project Name: .
Setbacks Front Back: Right Side: Left Side:
Novi= MENEM=
- Additional work to be vertormed under this permrt—check a appy:
OHVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers ElGenerator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
o
Cost of Construction: utilities: Sewer Septic Building Height:
Name d z� �t r -Name: o
Address: 1U il.Q )6 \T* Company: .'%CmaAAwnren ltn.. Vow+
A
CitState: , "Address: W v�'1•,
y:
Fax City: QOc '
Zip Code: � LV,�42. State::-
Phone No. 31 ..Z.l. ) \��i Zip Code: viIti Fax:J--)2e--Q�1� Oen-1
E-Mail! 'Phone No. 7."
Fill in fee simple Title Holder on next page(if different E-Mail. Ain C+n• ��^"+ { C.V1r�
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your prop .A Notice of Commencement must be recorded and posted on the jobsite
before the first inspectio . #y u intend to obtain financing, consult with lender or an attorney before
commen 'n ,work or r o our Notice of Commencement. f'
_Signature Owner/Less a gent ignature of Contractor/Lk ns older
STATE OF FLORIDA SSTATE OF FLORIDA J� 1
COUNTY OF COUNTY OF
The forgoing instrum nt was acknowledged before me The forgoing instrument was acknowledged before me
this day of . 0 20 G6 by this /off day of 20 �,I _by
(Name of person acknowledging) (Name of person acknowledging-A, , —&L, )
J,6�
Signature Notary Public-State of Florida} (Si nature of 4tary Public-State of Florida)
Personally Known '/ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produc Type of Identification Produced
N. BIECKY TALBOT �: ' IE TALBOT
Commission No. t +_ Commission No. Rc
f4lMISSION-P EE9 ,�:_: A9Y' 1fWISSION#;EE18Y
" t EXPIRES Ma D5,r,:'i �E� /
��/�o(G 9--3 ;s r:�R. y °^ 6 5.� EXPIRES R9a 05;?0 F6
r a eery oom �. %QYj 39M163 .=n
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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