HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '�1 0 `� Permit Number: 1S;0 3-a VO
RECEIVN MAR 0 9 ?016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /f
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �0-061C
PROPOSED IMPROVEMENT LOCATION:
Address: 70690 61AG ' Q / ,<f
Legal Description: , a; /7wiy '6(,� S AlsgL '/- O
Property Tax ID#: �?3- X00 1022 n- 000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
✓�e/�lOr/,2 .PSC/5�7//• �-f7//l �-�G� d�00 1�S�G�� �b�✓�'.e/y/l�i �P.Si�o
f 1/r�C�e �� `f sf�// volOajf
fir? � . & e C ��
6 r04 Z/is 6/f�
CONSTRUCTION INFORMATION:
Additional work tonGasTank
orme under this permit—check a appy:
❑HVAC ❑Gas Piping _Shutters ❑TRoof
indows/Doors
11Electric ElPlumbingSprinklers ❑_Generator
Total Sq. Ft of Construction: bo S . Ft.of First Floor:
/ 00
Cost of Construction:$ '�,y'0D, Utilities: Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name / Q A L GC ? e: Inrl'7-0
Address- 7000 //I,I'.?,,- 06Kl Company:
City: l'(O 1..1)("je State: G Address
Zip Code: ;3'o�fa Fax: City:_ /_ 'y-_ State:
Phone No. -77c?a`fl' - ;fYG Zip Code: _ yG/S(� Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page( if different E-Mail:
from the Owner listed above) State or unty License:
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 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 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
_Signature of 0 er/Lessee/Age Sign re_okjntrActor/Licek1ey older
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF :57-_ L!1 ftl COUNTY OF o'-Z.,lue
The forgoing instrument was cknowledged before me The forgoing instrument was knowledged before me
this�day of 20 &by this Z day of �/�/lG� 20 by
(Name of person acknowledging) (Name of person ack o 'e gtn )
(Signature o ry ,ub ic-S f Florida) (Signature of Notary Pu/' -State of Florida)
Personally Known OR Produced Identification Personally Known %/ OR Produced Identification
Type of Identif=EXP
Type ro uce
E = "..P�A<%: DAVID VAF099550CommissionNwa#F CommMY COMMISSION#FF09�.. oarch 9, 2018 °-9,�aF�oe, EXPIRES March 9,2018
(407)398-0153ROM
Revised 07/W2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS