HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�� �� Permit Number:
RECEI'"70 MAR 042016
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
PROPOSED IMPROVEMENT LOCATION:
Address: <W I g 3__e-S 2yZ CRsac 06, 2`s-4 32966
Legal Description: e?Ag(?GL U Lo 3 A
Property Tax ID#: .33AA Co IyGC73 coo Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Addit work toe performed under this permit—check a appy:
HVAC E]Gas Tank ❑Gas Piping 1:1MGenerator
Shutters Windows/Doors
Electric Plumbing ESprinklers Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ a2 U0
Utilities: _Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name G&8014J L.cisL�d ;OcwoAK Name: �&cNAXA 3. ol_)4APr
Address: 4)al -,5( Company: W 4
City: ?aalSk hicAs_ State: Address: G33 6Z,5 J RIZy.J 1,A)
Zip Code: 3` cf E5 6 Fax: City: '?-6-L Stater
Phone No. I-(y n Zip Code: a fOi0- Fax:
E-Mail: Phone No. �7r�oti �,�v ol,17bq
Fill in fee simple Title Holder on next page(if different E-Mail: !P:�Uv4_L<4 Rr (0- (`ry[,tSi NF77
from the Owner listed above) State or County License: OCpm IaS
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 Commencem
�'V A It� A
s
_Sign re of wner/Les a/Agent Signatu of Cont actor/License Holder
STATE OF FLORIDA STATE OF FLORI A
COUNTY OF fit'. L c 1'� COUNTY OF S�• X-10
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of *\qui 20 �by this y day of W�q{ .20 _by
(Name of person acknowledging) (Name of person acknowledging)
,sem'int ,
(Signature of Notary ublic-State of Florida ��s. \O<<aa (Signature of Nota Public-State of Florida) PG�vENs F\0�`aa
D PNN S�a�eol ZS�6�.
Personally Known OR Produce d�ntgfiat�b`f� Personally Known OR P�do Identi ��on eC q c 16 ,E
Type of Identification Produced� `��- xO Soe 5� ss '' Type of Identification Pro cy Exp�`e EE BB pss°
<e 0 P yP
Commission No. $ ; - D°� hNa\��. 1 Commission No. �5� R� �� (S J'%o"1
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS