HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater \qs Co
Permit Number: � 0(;;"t35T3
RECEIV'71 JUN 2 72016
a .
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: '- k-)
Legal Description:
Property Tax ID#: 1 IM — 1 AA Uax 1 - W'_)- D Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA-I'LED DESCRIPTION OF WORK: 3 .
wS 0J ev-Vuc� u_raw �MA.�_a6
CONSTRUCTION' INFORMATION:
Additional work to be nertormed under this permit-check all that appy:
11HVAC Gas Tank Gas Piping _Shutters Windows/Doors
9 Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 1 l�.(_� Utilities: _Sewer E]Septic Building Height:
.OWM R/LESSEE: CONTRACTOR:
Name 'U J Name:
Address: 4q SLAJ naeA PI( fAf e.. Company: C� L
City: State:-a Address: I 01c) l6
Zip Code:3q9ciq Fax: City: State
Phone No.M7 - Sn— LhZ Zip Code:_,:�AgVZ_ Fax.--F-(C--- 4(�
E-Mail: Phone No. - -Z.
Fill in fee simple Title Holder on next page( if different E-Mail: S M ( vY)
from the Owner listed above) State or County License: t2 SbO L643
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU'PPLEIVIENTALCQNSTRUCTI,ON 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 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.
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.
s
_Sign a of Owner/Lessee/Agent Signat of Contractor 'cense Holder
STATE OF FL O JDA STATE OF FLO DA
COUNTY OF Uc�� COUNTY OF J L6r\-e
The f�o(going instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ` day of20y this 31 day of 20 by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public-State of Florida ) s3 (Signature of Notary blit-State of Florida � '��
,�,�„Gl.�'�'- �GIVENS FtOtlda.,4
Personally Known OR Prod we`d` o��aer lr�' Personally Known „Oft P'r uc@ rMfii�
Type of Identification Produceddf°'" Type of Identification`Prod,4ged t OSDP 161 ,
V PUCE ate S 6 S a• ` r.��Fi} `c.'My E0 tssion# NOtary Ass yT;
`� t csxp ��o a ' �0 _1mm cFl�
n
o aCommission No.. sc Commission No. a
r,= e; ded�h
99
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Revised 07/15W14"ll
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS