HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - I�1 ,o Permit Number:
�IVA RECEIVED JUN 0 8 2016
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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
PROPOSED IMPROVEMENT LOCATION:
Address: 313 Elul'[OiavA
Legal Description: s- It
Property Tax ID#: 35a-7-50), —01�q-�l_j Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
OC4.\M b( '7 �1�ClC�.z C- WOkk-e—
CONSTRUCTION INFORMATION:
Additional work toe e orme under t -checkispermit a that appy:
HVAC Ei Gas Tank E]Gas Piping _Shutters Q Windows/Doors
Electric �Plumbing ESprinklers F Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ��� Sq. Ft.
E Septic Building Height:
'OWNER/LESSEE. CONTRACTOR.
Name VOL UICp�3 Name:
�R Vi ?1 A Company: c
Address: p y: �0-n�2 '� . G
City: �` V\ - State:r1- Address: Qo2 Q IVUA(--?cQ(1 k AVe
Zip Code: '334& Fax: City: 'PSL U State:
Phone No. 56( &7� Zip Code: 3*Lfq,�6 Fax:
E-Mail: Phone No. 772-7-77-00(C-)
Fill in fee simple Title Holder on next page(if different E-Mail: w ejC'P_U(V\G P 14k00-00- C,oiM
from the Owner listed above) State or County License: C-FG R-99097
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR'l1CTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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.
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
commencin or recording our Notice of Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Contractor/ cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5N ,l 1-)C 5I::'— COUNTY OF
The forgoing instrument was acknowledged before me The Voing instrument was acknowledged before me
thise day of Q 2011_by this day of :)U(1SL 201 by
(Name of person acknowledging) (Name of p on acknowledging)
(Signature of ry=ORProduced
lorida) (Signature of No P
ublic-Sta Florida)
Personally Known Identification Personally Know v OR Produced Identification
Type of Identificati Produced f Identificat Produced
A0
IrE*
Y KELLY MO aY
Commission No. ��' oAry Public,State of Igrl� fission No. 3 Notary Public,S of Florlc
aommission#FF 161 31 �' CommISS1011# 61331
omm.expires Sept.t ,2016 M comm.expires t.16,2(
Revised 07/15/2014
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