HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3��1 `� Permit Number:
{ RECE1'.'AD MAR 31 1016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division 11
2300 Virginia Avenue,Fort Pierce FL 34982 `
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential t
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line-z',,4',
PROPOSED IMPROVEMENT LOCATION
S t 1�1- J c -ems
Address:
Legal Description: r�
11/ `' c� Cc4
Property Tax ID#: �� '�S Lot No.
Site Plan Name: _ �- Block No.3
Project Name: / "" l _- (� 1, 'tom
Setbacks Front Back: Right Side: Left Side:
DETAILED bESCRIPTION OF-WORK..
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CONSTRUCTION INFORMATION _
,. _ .
Additional work to be nPrIormed under tis permit-check all tha appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing oSprinklers Generator Roof
Total Sq.Ft of Construction: SQ.Ft.of First Floor:
Cost of Construction:$/r �Q Utilities:Sewer 0 Septic Building Height:
OWNER/LESSEE ;CONTRACTOR
Name C Name: C
Addre s: �� _5 - Company: -
city: '� cuGState: (f Address:
Zip Code:' 4 Fax: City: F f State: /
l
Phone No. - Zip Code:3 �tom'�� Fax: C46-1 -r-70
E-Mail: Phone No. 7 7�-�{�/—S3 6 9
Fill in fee simple fltle Holder on next page(if different E-Mail: ce r- a ew Qotcyvni
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 CONSTRUCTION LIEN LAW INFORMATION:
.. .... ... ._. ..
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:
Address: Address:
C'dy: 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 wdh 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 Lude 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
commd)-icing work or recording our Notice of Commericement
_Signature of Owner/Lessee/Agent Siffiiature of Contractor/License of
86r-
STATE OF FLOgIDA STATE OF FLORIDA
COUNTY OF 1_o c k Q COUNTY OF
The forgoing instrument was admowledged before me
The forgoing instrument was acknowledged before me,
this-6\ day of 'P^A C . 20 �Eby this-6% day of IT—A(- V01 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P blit-State of Fldrida) (Signature of Notary lit State of Florida)
Personally Known _OR Produced l � taa 6 .. Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced r
NqNQP G\V o\Flotilla
Commission No.���'s - o eye°(g���#�� �o�a�y Commission No. S pu 'a�sapen 16,2oj6 f
`Gp(��� 5� a\ .�RyP�+<c�i� X10 o cn•ExP E 85916 s5
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Revised 07/15/; �;
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REVIEWS FRONV ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS