HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: aai
4
Building Permit Application APR 11 2016
Planning and Development Services PER14ITTINGSi.Lucie Count
Building and Code Regulation Division y, FL
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
_ Address:
Legal Description: Q U��h S Co �� I I I •- ly�C I
I ii U � 1 f,, ,l
Property Tax ID#: 1 -1 J"I - 10 I-'Q J(0L'J-000 -' Lot No.
Site Plan Name: r2 Block No. �—
Project Name: SJ r U
Setbacks Front Back: Right Side: �..L-eft Side:
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itiona wor to e e orme un er t is permit-cneCK all appy:
HVAC Gas Tank ❑Gas Piping _Shutters a Windows/Doors.
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: QS Ft.of First Floor:
Cost of Construction:$ 0 7") Utilities Sewer 0 Septic Building Height:
a - r ' ,... ., r v. 'i". sv .: #'.k isS �S 'K..:. at4,- �$ ''2 { •{,. �}
vi sr !� W0,420 sa'aa vim.. ,
Name J n mcs I Name: `I`�i—Qtica��Ser-
1
Address: I i)Z C1.r I I ai I� �-C C T I Company:___fl- L.
City: F IFI-c r C f State:FL— Address: IiS a to j. -79-PH
Zip Code:3Hq Hq Fax: 2, City: 1 0, k c`a C J,-,, Stater--
Phone No.q 19- (9��Q-2.55 Zip Code:33Y 1 a— Fax: J bi . S S•q0 5-9
E-Mail: Phone No. fl/- SS'• �{US'^
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: ka-F53 l
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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. - -
Inconsideration 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 6&recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consul'twAth lender or an attorney before
commencing work or recording our Notice of Commencement.
s
Sig ature of Owner/Lessee/Agent Sig ture ont/ r/License Holder
STATE OF FLORIDA (�1 I STATE OF FLORI
COUNTY OF �1 T I�.U/6 COUNTY OF 4411011 13ffic_6
The for oing instr merit as acknowledged before me The forgoing instru ent wa acknowledged pefore me
this day of n 20 Eby this 4—day of 20 49-by
1cvnn�s �D !� �rool�s
(Name of persona nowle ing) (Name of person acknowledging)
ignature of Notary Public-State of Florida) (Sign at7111Notary b/lit-.State o Florida)
Personally Known OR Produc Ide tifcation Personally Known �/ OR Produced Identification
Type of Identification Produced ffL Type of Identification Produced
JAMIE CHRISTEN GORE
Commission No. FF Il WT4 VMPBL
IC Commission No. o�PavaUe`� ANff�5gal UNG
STATE OF.FLORIDA * * MY cumMISSIea0tf#FF 951069
N 4 EXPIRES:A01 12.2020
NEExpires 8/7/2018 FOR pba nru oudgeINOtaryMum
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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