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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABJLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: to l9 i RECEIVED Building Permit Application Planning and Development Services JUN 3 0 2016 Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (7172)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Address: i' 11 -hue_. Legal Description: 1"1OIC1� ivik"lO�t�j Property Tax ID#: M) 601•- [)C)\"'i " ()®n`"1 Lot No, Site Plan Name: Block No. i Project Name; Setbacks Front _ Back: ^Right Side: Left Side: . _ I (DETAILED Fop Q CONSTROCTIQN INFORfV1ATION� mona+ wor to a er orme unclerthis permit-cneCK all that appy: 0HVAi C _Gas Tank ❑Gas Piping _Shutters windows/Doors Electric El Plumbing ❑Sprinklers Generator g Roof — — Total-Sq.-Ft ot-Construction:_ _ _ _S , Ft.of First Floor: Cost of Construction:$ LI�JO,�© Utilities: Sewer Septic Building Height: Name Address: \ n!q . Company:VQTQt1 BECL;\_e� V City: `� �i `Y �T State:_ Address: j q�% �,D''C� C�t+e y'e-, Zip Code:! rq-�. Fax: �y City: ?)N.mf m T)(� C State: Phone No! �] / 8 � / Zip Code: Fax: E-Mail: Phone No, 6306 Fill in fee simple Title Holder on next page if different E-Mail: o1C C�C .X Ch TI f�C� 0 from the Owner listed above) State or County License: �11� If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required. I I I SU:PPL�NIENTALYCONSTjiIJCTION #_1N I.A1�U II�P�QtMA7"IQN s Y DESIGNER%ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: � Name: Address: Address: City: I State: City: State: Zip: Phone: Zip: Phone: I FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable Name: 1 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 -stray: rte. _-'9 se ce,Say it Azith-�•o,Lir-Horne-Ov4ner- -Association-and-rr._view vour-deed_for aray r_estrietions which may 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 thel first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording our Notice of Commencement, _ -- s _Signature (Owner/Lessee/Agent Signature of Contractor/License Holder. STATE OF FLORIDA STATE OF FLOR A- COUNTY CIF 57 -I-Ueld COUNTY OF WU►'I The forgoing instrument was acknowledged before me The fQ�gping instrument was acknowledgedbefore me thls��daiy of_ -T t,,U.e_ 20/ this day of l5� '� 20 v by (Name of person acknowledging) (Name of person ack owledging) (Signature 6rNotary Public-State of Florida) �ersonallyy gna t of Nota ic-St f Florida) Personally Known�_OR Produced Identification Known OR Produced Identification_ Type of Identification Produced Type of Identification Produced CommisCommission No;l�:4 ' '� � 5fa IACD N L r,, '✓coMrstA 6 • •r MY QMMISSIOM r FF918a04 _-- Excar�SS(OA it F_�iQ2j3- --- -- $July 29,207 //�� � EXPIRES Sepbber m07,2019 Revis aoTy QO114 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE -- ------ --- — ----------------- COMPLETE INITIALS