HomeMy WebLinkAboutBuilding Permit Application T ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
` � �, Permit Number: -7- V
(bEgVED
Building Permit Application JUL ® 7 1016
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-1 1)4?ROVEMENT LOCATION
Address:715 b
i t
Legal Description: 3 S 11fuw
Property Tax ID#: a y o 6 - 3D_ 3 oda C' Lot No.. N/A
Site Plan Name: in) A ` Block No.�
Project Name:W IA A(,.C>L5 0 C-M 0 L_ ( (/ o N
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION"OF WORK
Z"o - CT-) a u C v R s- Yo
a...+
CONSTRUCTIQN 1N.FORMAThON 3
Additionalworktoe e orme under this permit-check k a apply:
1]HVAC E]Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric ❑Plumbing Sprinklers E Generator F�Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ a, 1)y Utilities: Sewer ElSeptic Building Height:
OWNER LESSEE CONTRACTOR
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a. .
Name_ Name: U�
Address: 1(2 .S rQAfZe—' (S S' �S A vT5 Company:
City: U_)F5-1 S I'l-o F-AC14 State:F4 Address: 017t'b6_
Zip Code:3 b`-1 O 1 Fax: City: ' < <l�-V C'E State: rL
Phone No. Zip Code: �'9Sa Fax:
E-Mail: Phone No. -7-7 a - - 4 k-?1 Do
Fill in fee simple Title Holder on next page(if different E-Mail: P fPLZW7� CSL 66v�
from the Owner listed above) State or County License: CG
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
T
S,UPPLEM.ENTAL CO'NSTR`UCTION LIEN LAW INFORMATION: x
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Ad d re ss:
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
commencin ork or reqoringour Notice of Commencement.
- s
a ' 'I N. Si nature of Contractor
_ nature of Owner/Lessee/Agent o: �__ g /License Holder r
STATE OF FLORIDA ,°;;+,, STATE OF FLORIDA
COUNTY OF o COUNTY OF ,S7 u�� �—
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6 xn C
The for oing ins ru a as acknowledge efore 90 o The forgoing instrument Jwas acknowledged before me
this day of 20� by N this 2 day of Gc/ 20 by
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S-71C V fee 3m"-
(Name of person acknowledging) (Name of per ibn acknowledging)
(Signature of tary Public-State of FIVida / (Signa re of Nota Public-State of Florida)
Personally Known OR Pro u d I tificati Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
KIMBERLY A.ALKIRE
Commission No. (Seal) Commission No. G��O/;/ ki'-.6
I COMMISSION#FF22013
EXPIRES:APR 13,2019
Branded through 1st State Insuran ill
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS