HomeMy WebLinkAboutPermit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: CY Permit Number:
IIIII�
OEM RECEIVED
Building Permit Application
Planning and Development Services JUL -6 2016
Building and Cade 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 ar ow at the end of line
Address: 3 i O,- 161-59n , C.
Legal Description: Eve- 4
Property Tax ID#: t -191 - f,/-( -Q(XJ • Lot No. 6
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
fir
• rew iyu-4 J 1/ rn eta-
Additional workto ebej orme un er t is permit-c ec a appy:
(].1
HVAC t Gas Tank ❑Gas Piping _Shutters F]Windows/Doors
Electric Plumbing Sprinklers Generator etalloof
Total Sq. Ft of Construction: J(11190(0 SQ. Ft.of First Floor:
r
Cost of Construction:$ <tv3-76, Utilities:0 Sewer I Septic Building Height: t
Name Name: F_
Address / r' Company:
City: State: Address:_5�! C ✓
Zip40+ 3� - _ Fax: City: <J 1a_1A_ State:
Phone NO._456P l-0 2 -7'7-7y Zip Code: 31-(W-7 Fax: —7"lc`� 7 �3
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: cocuy r'S.Co
from the Owner listed above) State or County C nse: 0—f, . {3,2.621'- i
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 thepermit 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
commen ' w or recording our Notice of Commencement.
S
_Signature of Owne Lessee/Agent Sign ure of Contr ctor/License Holder
STATE OF FLORI STATE OF FLORIDA
COUNTY OF Q Vl COUNTY OF �
1n
The for oing instru ent was acknowledged efore me The forgoing instrument was acknowledgedbeforeme
this day of 20/�y this I day of -1U�— 20 Ito by
14'c� e u51hl C-. Foe
(Name f person ack ledging) (Name of son acknowledging)
(SignatVile of Notary Public-State Flori a) (Signat a of Notary`Public-Stat FI ida)
Personally Known OR Produced Ide tification� Personally Known � OR Produced Identificatio 0111111111111/1/ k/
Type of Identification F uced ��� Type of Identification Produced . r'r°.
101111111Q4111111j •`�pMMTssjo_'
Commission N r� (Seal) Commission No. F£�1345 (Seal)=#: ���Y 17 O
`�� '�pMMISS/py'•. �T i = •isi
4.
Revised ''�` °°°
1.1 state
TATP
StateM;••• `r�� 111111111111111 `
REVIEWS °rr �� 'NTNG SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
lilt101 �EVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS