HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5\% \.t Permit Number:
RECER"H MAY 0 9 2016
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_ Building Permit.Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 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 F' ,
PROPOSED 0IVJ*OVEMENT LOCATION
Address: e-A-A _Ky-C(In P G V( I'I VA LQ e `
Legal Description:
Property Tax ID#: 3`i�`1' 501 4CSo-� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:' Left Side:
DETAILED DESCRIPTION OF,WORK
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t .a qC IC CUve,�ed Payf d ot, mab,lc &;�e_
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CONSTRUCTION INFORMATION
A ibona wor to e e orme' un ert is permit-c ec a appy:
HVAC E]Gas Tank ❑Gas Piping _Shutters Q W indows/Doors
Electric 0 Plumbing Sprinklers Generator FIRoof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ (o n Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR -
Name W Name: c.. C-
Address: � S i �1zs(/ d Q _ 1/Vi Company: l r v�
City: S UGG� � Address: fo Le:
< State: c.
Zip Code: Fax: l City: -_ f !cp-c� State:
Phone No. `�l �? Zip Code:3 OF 6-1>_ Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or Coun icense:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMEfVTAL CONSTRUCTION U LAW INFORNG4 ION
DESIGNER/ENGINEER: YNot Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
Mr. City: State'
Zip- Phone: Zip: Phone:
EEE SIMPLETM HOLDER: _N Applicable BONDING COMPANY: Not Applicable
Name.— C G C Cf i_" Name:
Address: a Address:
W. P+- 51- Locbe, P-(— City:
, Tip-.3 "y4 51�_ Phone: -7? .)---332--c-/v5-4 Phone:
1 aerft that no work or installation has commenced priorto the iss mce of a permit
St.Lude Co��ty kes no representation that" gra fi a permit will authorize the�t holderto build the subjectstructure
which is in Ca=kes aarr��yy a�ppircabie Home Owners Aspociation rules„bylaws or and covenants that may restrict or prohibit such
struc0ure.Please anrrsultw�th your Home OMrtrets Association and review your deed for arty restriedons whidr may apply.
inconsideration of the granting ofthis requested permit;l do hereby agree that 1 will,in all respects,perform the work
in acwrdancewith the apprmW plaits,the Florida Srdltft Codesand St LurieCormtyAmendrrrenM
The foliowarg building permit applications are exmnpt from undergoing a full=wurrency review:room addrit o' res,
accessory suucum s,swimming pools,fences,waif sfigns,screen rooms and accessory uses to another non-residential use
WARNING TO OWNElt Your failure to Record a Notice of Commencement may rewlt In Vow paying twice for'
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite.
before the first kwe c ion.If you intend to obtain finagang consult with lender or an attorney before
comMSaft work or recordinn vour Notice of Commerroem
s
-_S ire ofOwm1 trwWAgent of Contracbor/tmer�se Holder .
STATE OF FUORIDA STATE OF RLbRIDA =
COUNTY OF % c COUNTY OF
71ee rgoing untr �
tmntvras admowle�ed before me lite utstrument was admowledged before me:
this dayof V-*,:i . ZO Lb9 th��.dayof4� .20 „ lib!►
CL ,t
(Name of person admowledging) (Name of person admowiedgut)
(Signature of Notary ic State of Ficrida) -, �(S a of Notary tic-Stage of Florida)
R OR Produced NS
_ F�oc1d Known �4 0 -- teG�:a
Known OR Prodrroed.[d "
Type Identification Produced lc 5 -2�T of iderrtfication Prod clary iii S SaD e M 6
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COrnmi590n NO. 4.54: `. "�. (�R�rss�r N oa,N�a�y mission No_ S `; a<`My �1 h Na Tonal Notary Assn. f
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iii ll� W �ft` r
Revised 07/15/2014
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