HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'" `Af, `�j r \ Permit NumberoS^ a0l
RECEI4�rD MAY 04 .2016
•
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
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 yj ��5
PRt1P'O$�D ffVIPR0I�EM�NT�.LaCA�T110N r
Address: 4'C,:<30 _S e"V. �Qi;` �dU_� �.rl 5f'�� f�Y G`-�'YE � 3 t/5?,5 7
Legal Description:
Property Tax ID#: 3 5a a— OOd o1 add — 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D TAiLED:;DESCRIPT10N"OF
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Add itional worK toe performed under tis permit—c ec a apply:
HVAC 1,Gas Tank DGas Piping _Shutters O Windows/Doors
Electric 041'Lumbing ❑Sprinklers E Generator Roof
Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$ UtilitiesSewer Septic Building Height:
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Name Je�-dd , Oo10 \N\ Name: ::�c!n / ,�r� C'�"c:[ji r-1
Address: S(��' -S _ C c-c?ca-� z l-!li%. Company:_5'L4 r-�. -
City: ..�r.(i 7r i r ,N...r�j State:fZ Address: ��� ✓J;�Cr�C' � ._.�� -
Zip Code: 3 15-7 Fax: City: _5'7'_•<<r-1— Stater
Phone No. Zip Code: a-'J/?C?7 Fax: .z97-
E-Mail: Phone No. -772
Fill in fee simple Title Holder on next page if different E-Mail:Vic'► 1 /rte: gi A
from the Owner listed above) State or County License: C F(C
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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ttrP� �Ru lot4:LIE �� IN-FORMA-none;
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Noz Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone: 1
FEE SIMPLE TITLE HOLDER: —Not Applicable BONDING COMPANY: ,Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone: I!
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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S ature of Contractor/License Holder
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_Sig�tc^rre i�0inrrte�/lessee/went
TATE OF IFLORID STATE OF FLORID
COUNTY OFQ .t� COUNTY OF (,,E
The fo oing instigentwas acknowledge before me The forgoing instrument was acknowledged before me
this day of 20 Cbp this r:?.� day of ".CXt— .20 by
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ame o person acknowledging) ame o erson acknowledging)
natvrA of otary Public-StAte of Florida) (§knatf ota b c- to of Florida)
Personally Known OR Produced Identification Personally Known \/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
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Commission No. ' �swslo KrERMe�52 1 Commission No. ,.,�,�"�¢ M `
MY COMWSSION R ff 852551 f 4
a 0DWIXEXPIRES.a Lerch 18 2017 rmu mot ; EXPIRES:March 18,2017
Revised 07115/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SFA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
I N ITIALS
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