HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ' 9 Permit Number: ��0 _v
Building Permit Application
MAR _ 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 11111PROVEMEN LOCATION
Address: 9600 5 06-tg2e �r— f/08,!
Legal Description: NA 5-oL -4 U/Vrr MV0/(l S
AI IT —
Property Tax ID#:_ SY/ — S/7- �O() — _ - Lot No.
Site Plan Name: %'/MAI Qd/ Block No.
Project Name: f olf 6.011/5
Setbacks Front dV f}' Back: /L/y Right Side: Left Side: N�
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77 7777, 7
DETAILED DESCRIPTION OF.WORK
2 G4EWWOO,/2� //�/GS 0�1f171_A16 SSU
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CQN--RO N"INFORMATION'-
Additional work toe e orme
under this permit-check a appy:
HVAC Ei Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric ❑Plumbing 11 Sprinklers I Generator _Roof
Total Sq. Ft of Construction: / Al Sq. Ft.of First Floor:
Cost of Construction.$ i Utilities:Sewer Septic Building Height:
01NNERjLESSEE CONI'RACT�R '}
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�...>�. . ,.. . .. - a .�.
Name /ylbK /i1--' Name...
Address: U Company:
City: JrIyApl/ 13trd,it k State:A, Address: 1'77., �f'
� -�
Zip Code: t4 Fax: City: �� State: [
Phone No. / 7i 1 14 Zip Code: ?`11 4L-1 Fax:
E-Mail: Phone No. r'1 -004 b
Fill in fee simple Title Holder on next page(if different E-Mail: CV-
-
from the Owner listed above) State or County License: 4n6C .1 MZ W�3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN:LAW INFORMATION
DESIGNER/ENG t
INEER: 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 po Is,fences,walls,signs,screen rooms and accessory use another non-residential use
WARNING TO OWNER/cWcdinp_Vour
f 'lure to Record a Notice of Commencement res in yo paying twice for
improvements to yo ty. A Notice of Commencement must be r ord and sted on the jobsite
before f' insp cyou intend to obtain financing, consult len r or attorney before
com en i wor or r Notice of Commencement.
Z- /Z L____11
s
_Sig ature of Owner/ ate/Agent, Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _Sr COUNTY-OF '�
The forgoing instrument was acknowledged before me The forgo'ng instrument was acknowledged before me
this Tday of A/!9� 20 by thisay of _ �� 20/�by
(Name of person acknowledging) c (Name of person acknowledging)
(Signature of Notary PubTi—c--'State of Florida) (Signa of Notary Pu'bli'c State of Florida)
Personally Known�—,-' OR Produced Identification Personally Known `AOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ,,'"*X'. I. rt�M.��AAUMOND Commission No. s`d.�Y",��: (SSII�M•GAUMOND
MY co11P1 N FF 173907 a ,.: ;t: MY COMA�ISSION#FF 173907
•• 4 EXPIRES:December 7,2018 a: a EXPIRES December 7,2018
Bonded Thru Notary Public Underwriters ey0'
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS