HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: s l 1� Permit Number: \�d3' 0 '14
RECER'-D )1AR 31 2016
o
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 t
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,\U-,n
PROPOSED IMPROVEMENT LOCATION ,'
Address: 1
Legal Description:.n 6 �3 Ill-C,44 L A cy-P A ly hIo,�JA LKJ 09.231FO_
Property Tax ID#: 61 e 3 —0J-0 Lot No. Ac
Site Plan Name: C, 4! r Block No. 63,
Project Name: U �C-1 frwyc►fa L'S
Setbacks Front Back: Right Side: Left Side:
DETAILEDDESCRIPTION.OF WORK
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CONSTRUCTION INFORMATION
Additional wor to (epe orme under tispermit—checka appy:
❑HVAC L_J Gas Tank [—]Gas Piping _Shutters a Windows/Doors
Electric 1:1 Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: /(0 Sci.Ft.of First Floor:
Cost of Construction:$ a Utilities:LJ Sewer Septic Building Height:
OWNER/LESSEE ,CONTRACTOR
Name JKrf <—QN M Name: cQ C
Address: �/� �� )0,/(�-P_ Company: r IM-VZ--,
City: I(at-�(� State:R, Address: tt--
Zip Code: _� Fax: '( City: F f W,C:r� State: FC—
Phone No. Zip Code: Fax: 7 7 7610 �f
E-Mail: Phone No. 7 7�—�{�!—.,.3 6 �/
Fill in fee simple Title Holder on next page(if different E-Mail: ce �eCI
from the Owner listed above) State or Coun License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUMON LIEN,LAW INFORM TION
DESIGNERANGINEER: _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- t
Address: Address:
City. City:
Trp: Phone: Zip: Phone:
I aerft that no work or installation has commenced prior to the issuance of a permit.
St.Lude County makes no representation that is granting a permit will authorize the permit holderto build the subjectstructure
which is in conflict.with arr��yy-a�pplicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult w7th your Home owners Action 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 awardance with the apPoved plans,the Florida BmWng Codes and St Jude County Amendments.
The following budding 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 msidential use
WARNING TO OWNER:Yourfailwe 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 finanping,consult with lender or an attorney before
commencing work or recording our Notice of Comm enceme
s
_Signature of owner/Lessee,/Agem Signature of Corrbador/License Holder
STATE OF FLORIp STATE OF FLORIDq
COUNTY OF S . L v c'� COUNTY OF SSC • L v c'�
The forgoing instrument was admaiviedged before me The forgoing instrument was admowledged before me.
this�day of m a{' . 20� tiY this %\ day of TIN 0,'C
.20 �� bl+
Cat 0. CgV-�ref
(Name of person acknowledging) (Name of person admowledging)
(Sgnature of Notary Publi-State of Florida (Signatu�of tary ubGc State of Florida)
'' 1VENS
., NNP G i Florida � �
Personally Known �IbPrduoed pl � t Personalty Known ojPcoduc E�y�gQ� �
Type oflderhtificatio ` et( �o1rEyt�ices.� 5��g1 Type ofldenfifiCatio `f�d No,ary� gtatP�t Florida w
,oP c My om issioo ,t d`Noc ".` M Comm xpires Dec 16,6N16
Commission No., � 5 = c W�n 1a ion t:ommission No. _ Y EE 9587
_ K. . Comm, Assr
once Rptr i�9; PC h National Not
%;e pP F�` sem ., ov c;°.•` Bonded Throug
III11\ 111111 .rm�:T�+'�'
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS