HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ Permit Number:
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Building Permit Application MAR 3 12016
Planning and Development Services
Building and Code Regulation Division PER;IITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie Co�my/F�
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION ,. ,
Address: Z: ►� , V"L �
Legal Description: 20-4 i✓tom .PctIrg--, :51 E� �MI-OT/9 ,? Z 42
( o•a-:i-L a4o (oag-71 ►6ac�)
Property Tax ID#: 4o 0.3/0 7 ' Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
I.-Co'N'STRUtTI(i.N'INPORMATI'ON:-',-.
Additional work to be performed under t ispermit-check all appy:
❑ E]Gas Piping Shutters RWindows/HVAC Gas Tank in _ Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
010
Cost of Construction:$ 0"ol-TU Utilities. —Sewer[]Septic Building Height:
OWNER/LESSEE t CONTRACTOR:.
Name Name: �/�l�il�gC�ir14C��
Address: £ d Company: /Z Ek {eyiDrS.zh C
City: �+ A/I r�e , State: , Address: 1Qc.9I_!,f J ,%f ,rte 4f _
Zip Code: 3L}�1'7�� Fax: City: State: ' .
Phone No. -7-79 70'766 Zip Code: Fax:'77,?g)/-63 77
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: j�1 �7rPyfi��:o�S-Cjoi�+
from the Owner listed above) State or County License: 42,6(2 z4E�g6(o 51�>
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, 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
SI ature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLO A STATE OF FLORI
COUNTY OFF li/�. - COUNTY OF
The forgoing instrument w sack owledge efore me The forgoing instrument as ackn wledged before me
this day of 0� by this�( day of 20 by
Q n 6 J
(Name f erson acknowl ging) (Na o know dging)
O(SignaNota Public- lorida) re of No Public- ate of loridaKnownOR Produced Identification Personal y Known Produced Identification
ntification Pro dentification Produced
ic °G� Jos po' "C State of Florida Commission No. 'QYr+ a
Commission No. 1117' Hane Alberico °Q Notar�public State of Florida
pyo' My Commission EE 827424 yy. Q Joshua Shane Alberi
�osct° Expires 08/1612016
°►� E3 .
xpires 08/16/2016 4
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS