HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I QO
Building Permit Application MAR 17 2016
Planning and Development Services
Building and Code Regulation Division
W(}F�iITTI��C
2300 Virginia Avenue,Fort Pierce FL 34982 :c: County, FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential X"
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IIVI:PRO/VEVIENT LOCATION,
Address: Sii�� F -1-eSP4C �1✓
Legal Description: LdT 3a III IC 8
Property Tax ID#: Go dol-<)131-44o0Lot No. 30
Site Plan Name: Block No. a
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION;INFORMATION
Additional work toe e orme e under this
n rmit-check all that appy:
HVAC. 0 Gas Tank []Gas Piping _Shutters ❑Windows/Doors
11 Electric Q Plumbing []Sprinklers [Generator F11*11 Roof
Total Sq.Ft of Construction: I S .Ft.of First Floor: ��
Cost of Construction:$ Utilities: Sewer F]Septic Building Height:
OWNER/LESS,EE ti ,- CQNTRACl'OR:
. a
Name TCn.f,C r Name: &I
Address.;S-'UY '`For: piC_�C��..?�� Company: " yrf
City: .9.0 r1 e, Stater Address: I X163
Zip Code: Fax: City: S4Q Lv State-.-F-4-
Phone
taterPhone No.770 3 3� `��Jrd Zip Code: Sit'K Fax:
E-Mail:—,- Phone No..-/,;P.?-3yl✓- -7 7'7D
Fill in fee simple Title Holder on next page if different E-Mail:'je goo):.t f L i- C eo"44
from the Oauner listed above) State or County License:44 C G 1-1-1001$ 3
3
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,l 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.
_Signature of wrier/Le gent Signature of Contra License
V'el'
STATE OF FLOWDA STATE OF FLORIDA ,
COUNTY OF 0/f C vc C COUNTY OF ��� t/C .
The forgoing instrument w s acknowledged before me The forgoing instrume t was jpcknowledged before me
this—�1--day of MgrG 20 14by this 11?�day of YKt re h 20 16 by
I&I -gid ) N44k
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-St •F •r i nature of NotaryPublic-State of F da iac4:�.9
Personally Known OReducec�'et�iifica = Personally Known�_OR Prodd'tinc
Type of Identification Produced�1�� 1224?. :* Type of Identification Produced .F x5_
S :o�,`��
Commission No. �Oi,� Q\���` Commission No. �G���NidSN •.e•\oP `
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS