HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ✓ s- Permit Number:
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Building Permit Application JUL - 7,2016
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
PQSED I1VrPROVEMENT LOC' -T-
PRO
Address: - JOO Fa_f &Coo l a 2i 4, 495-6
Legal Description: �,i �� L" C� � � �q -Liss /USd �� a�g � �'r� - ����. �4
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roperty Tax ID#: 2_3I` 2-1 ALPO oc.) o o - 4 Lot No.
art eta nre: 2-3 Ii z d 0 6 D D 0 b is—
-� Block No.
Project Name:Y1. L_i7f'_ie: �J+�I I
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION 4F WORK
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NSTRUCTI:ON INFORMATION:
Additional work to be erformed under tispermit-check all
inal u. appy:
11HVAC Gas Tank ❑Gas Piping ❑_Shutters Windows/Doors
Electric LJ Plumbing Sprinklers E Generator 13 Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer®Septic Building Height:
OIIVNER/LESSEE = CONTRACTOR
Name51-- L.ur-tee. SDA+v' Name: 105S 11 IYA(pid
Address: Company: R l,S Q aAtP R Sz,!Aivns LL 6_
City: State:_ Address: 1Z.qA 41,4 t3P,r1 9.
Zip Code: Fax: city: C40;&_ State:/''(C
Phone No. Zip Code: Ulyz Fax:
E-Mail: Phone No. 917"29q g.334 /t
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Fill in fee simple Title Holder on next page(if different E-Mail: / FRu i f+CF) kT1 iia js1
from the Owner listed above) State or County License: Cr°I~C.'. I V 2'71,14
If value 0f construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER ENGINEERS _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: 4ot 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 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`restricUons which may apply.
In consideration of the granting'of this requested permit,l 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
commenciUg7vvork or recorcijxig your Notice of Commencement.
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gnature of Owner/Lessee/Agent Signature of Contractor/License Holder
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STATE,OF 4STATE OF �4 C6
COUNTY OF COUNTY OF • MC1
Theorging in en was acknowledged before me The forgoing Instrument was acknowledged before me
th'i qday of ( 201(1 this� �day of ' 3 L 20 KQ by
R-w--
(Name of per a owledging) (Name o erson acknowled ing)
(Si .of Notary Public- tate of Florida) (Signature of Aotary Public-State of Florida)
Personally Known L--'15'R Produced Identification Personally Known -"- OR Produced Identification
Type of Identification.Produced Type of Identification Produced
Co eal) Commission No. (Seal)
Notary Public,$tote of Texas
i 9
,41 h 1 1 201 `p�pPY P°�4
�` Marc , 9 °r°too Notary Public,$tote of Tex
My commission Expires
So tember 15 20.19
177777
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS