HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Date: l(u Permit Number:
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Building Permit Application RECEIVED
Planning and DevelopMAR ryment Services
Building and Code.Regulation Division MA 2L4 2016
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
A
PROPOSED IMPROVEMENT LOCATION a
Address: 6, nrbor iiqyPP® �f��IQj1 /t I'nl,l-e FL �'7�D2
Legal Description: � ) y-er porn ! () nil 01 11 _20 lot 2 MQP s�4122 N J
� 0A 3915 !--167
Property Tax ID#: �),Iq 1 q .F�Q ) o 003D e Goo — � Lot No. Z
Site Plan Name: Block No.
Project.Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONST
RUC 50
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Additional work to be performed
. under this permit-cheCK all appy:
❑HVAC E]GasTank ❑Gas Piping in Shutters ❑Windows/Doors
11 Electric 0 Plumbing F Sprinklers F—]Generator 1:1 Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ 11 X3. 5 n Utilities:Sewer[]Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name M(10(a 10 r'11JWrrin_t�_j LLG Name:G-Cor . BeUD
Address:7` �'� ''1'!�'' -i;1')tQlu P roi W if C/ Company: /� 'fl�''i 1 r co nl ,
City: �`:� 1(�: �Qr State: EL Address: 2Q 0f0a _
Zip Code: Fax:. City: (A}l�t PQ 1MCn State: F�.
Phone No. 5 b1 5� 2OZ) 7 Zip Code: Fax: �5(�1 28 ^'>I 2'
E-Mail: Q 6 (��r�dlQ( CQ- COrn Phone No. �9 (D '` (9
Fill in fee simple Title Holder on next page ( if different E-Mail: info eJ On.l firmir,onyr'0 . 661n
from the Owner listed above) State or County License: 11 F(J 142-7'27(9
ttotc ocenz,
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION'S
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 Commencement.
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Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
Imo. , ,.. .�_.
STATE OF FLORID Ifi., t; STATE OF FLORID
'ol�J'c9`r
COUNTY OF / 4. _Z� �l COUNTY OF� „
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The forgoing instrument was acknowledged pefr Thefo gig�g instrument was acknowledg%by
fore me
this day of J') / �. 20�(p b z mM m this ay of �A �(',�'� 20
ZI
G2110Q, PDW -
d �m
(Name of person acknowlecigi g) o (Name of person acknowledging
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(Signature of Not6rh Public-State of FI rids ) / (SignaturN of Notary Public-State of Florida )
Personally Known OR Pro-ftd Identific tion—",� Personally KnownPu
y \ OR Produced Identification
Type of Identification Produced '�z Type of Identification Produced
Commission No. (Seal) Commission No.
Jeane .Marie Brown
's COMMISSION OFF916765
Revised 07/15/2014 '�•;gi;;fl,;:°.` w-um.AAROWN01ARY•COh1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS