HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO
/MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date.-
cLv Permit.Number: /
^ RECOD
u.
-- wilding Permit Application MAR -9 2016-
Planning and Development Services
Building and Code Regulation Division
2360 Virginia Avenue, Fort Pierce FL 34982
`Phone; (772) 462-1 553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To. Select from dropbox, click arrow at the end of line
.. ^.r:. ~•tet ..s,v�+-rz^ ea,... : ..y w ^5j 4,�.r-u.,^�K S";�t u'' ', r' �".t 1 r f"'^_ µ. r "'t s « �lam' r' R X i'3
4 : ri i ._P u5 1 J u='. r?.'(i1` 4t
N3�f .r �c„c "a�p:* t x°'r it t t L -. c.^"s P��"h-��•r + �' t
�fi x f s r t3'"°sk �14ft�...�r�t�'3� r
6::2('izJ
(- S r n i0d 2Z - I(,.. 14 D 2 I Z- M 4_�b nA r5 g?8 ` 9531
Property Tax ID#: Lot No.
Site Plan Name: = Block No.
Project Name, SJcak fn SUYI r%�r `�D4�7
Setbacks Front Back: Right Side: Left Side: _
'.I..t
q
DT�ID ascRIPTIoI�
�f ,:�i, n:F'i!tt, tx .f i'ntt .c3J�w" .3
46 2-
11 l 47_� 1•� ":. Y �i ,1 v"'I`NilV�r►���W ♦ -
="5 t r n t ,.n t x, tr x+g- -t ^+ $ ,ro ..<.:1 ,� F ve pc a .,,x '�' _'... �h C r'Y•Fm X
ISO ,pS�e r,;3(..
i%trae
' ./_J �� �� ;b ��w�S.t�1�;��i4 .�f ca k �, �' ....r.r.__4t. ,(.wr€�f :..•} a. _Y .}..�_in'f.{.'S$�... t. .{, s1,a lr„o �.
ittona wor +to (e�e(r orme ” un er t is permit check all appy:
HVAC L__`_1 Gas Tank ❑Gas ng _Shutters W
indows/Doors
0Electric' 0 Plumbing OSprinklers Generator l�G! Raof �11f
Total'Sq. Ft of Construction: �� ,�. S . Ft. of First Floor:
0�
Cost of Construction: $ 0: Utilities: _Sewer Septic Building Height: /S
Rs
`AN" R-,',j%s. - . r£'�`a!n
,.,
Name Name: re!
f P 0c)
Address: 32-6- Company:
City " 1"y�4— rye State: F, Address:
Zip Code: 3 Q(1_(4 Fax: City: &9R Ltit Gt,� tate
* ZipCoe:Phone Ni 335'' '
E-Mail: Phone No-N2_) 3,3 - 9TIM
Fill in fee simple'Title Holder on next page {if different E-Mail: .0 01 rr, amzca q ="G
from the Owner Iisted above) State or County License: ' .CC( a3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
dr
'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:
ity: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
comm ork or recording our Notice of Commencement.
_Signature of Owner/Lessee Agent Signature of Contra cto rILi66nse der
STATE OF FLORIDA1 STATE OF FLORIDA
COUNTY OF 5f•L� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_7 day of 20/-by this-day of M mJ,%. 20/ by
NkA b S. 400W
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known VPuOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. o�"":.:°ei,� BUMA.ROESSNER Commission No. ��"a:��ai,� BIS@ ROES9NER
* MY COMMISSION 4 FF 211275 * MY COMMISSION t FF 211275
;X April 3 2019PXPIRES;April 3,2019 J
�f4TFOFF���`o' Bonded Thru Budget Notary Services �'�rFOFF�O�`oe Bonded Thru Budget Notary Services
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS