HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /-
Date: s ( �— Permit Number:
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RECEIVED
Building Permit Application MAY -12 2016
Planning and evelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)1 62-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVE
--MENT LOCATION:
Address:R2. 1 S L LIC Bte, r/ '0/-eyc4
Legal Description:
Property Tax ID#: I y 3 3 .2-
to- Cin n 3- a 0 05 Lot No. 3Z /
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to e performed under this permit-check a apply:
HVAC n Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$—)(j0 0. 00 Utilities:Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name J<A4, 10 4 F F i 1,a AeS Name: -1—in %I G- i'v✓Py5z-v
Address: 31 IV .11
S �(2isc �� Com an : f SQvv��cr LLC
City: �I P 1",4 V C^e. State:F Address:: Z_Z v,d-S,!o C
Zip Code: !y!F Fax: City: Pd, ST Lc[c r a- State:
Phone No. 722— N 6 2 11 Zip Code: 3 IL/ 9'S;3 Fax:
E-Mail: Phone No. :77 Z Zy / - 9 e-9-9
Fill in fee simlpie Title Holder on next page(if different E-Mail: `(—a,�� u p /SU ® VdL a_ <O N-
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from the Owner listed above) State or Counc/ty License: E C 13100 c l/Sg
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN.LAW IN,FORMATION:'
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: I State: City: State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no or 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. Pleas consult with your Home Owners Association and review your deed for any restrictions which may apply.
In considerationof the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance wth 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 rNork or recording our Notice of Commencement.
�1>�...*'��4i
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"mak. Sin re C or License Holder
_Sign ur f r/Lessee/Agent � g / e-
STATE OF FLORID A° �'
COUNTY OF � '�..a '� STATE OF FLORID
m COUNTY OF n x`a
'0 ac m�x
The forgoing in rument was acknowledged bei The forgoing instrument was acknowledged bef
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this day o 20�� y W this day of 20�� °'g
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SLC C QTS
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(Name of perso acknowledging) 182 (Name of person acknowl • g)
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(Signature of N tary Public-State of Florida (Signature of N t Public-State of Florida)
Personally Knom n ORP u ed Iden ificatio Personally Known R Pro c d Ide tificatio
Type of Identific tion Produce Type of Identification Produced
Commission No (Seal) Commission No. (Seal)
Revised 07/ 5/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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