HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:. �1 �rP Permit Number:
.4 _ .. RECEIU❑ JUL 12016
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 1( Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line W Cote
PROPOSED IMPROVEMENT LOCATION:
Address: RSSt) S DCS 1 02- 703
Legal Description: '�'IS�bz - &
I SLA'nN O i A C-D N 0'ayP l ( 2 Zy J ,
Property Tax ID#: yf-o2, - (00( -Oos-7 -000-Z Lot No.
1,
Site Plan Name: '7 oL," Block No.
Project Name: qO,4ri1b
Setbacks Front Back: N A' Right Side: Left Side: N A
DETAILED DESCRIPTIOUOFWORK:
UV/nio ow - 00" , 7�G4C&vi6VJ" !,�o,o&?viti
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CONSTRUCTION,INFORMATION
Additional worlkto be nertormed under this permit-check all appy:
HVAC Gas Tank OGas Piping Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction: $ /d/906 Utilities: _Sewer 0 Septic Building Height:
OUVNER/LESSEE `CONTRACTOR.
Name %MV& NI 4 Name: 6W06"iN/
Address: o'Aao6 cC i�� 7�2 Company: _TfN U/LJi/d/G�i`l
City: V.4"ilao Z_/A, State: /L Address: / i�-'OX&Mff— C
Zip Code: (a f71 Fax: City: S T QStater
Phone No. (o 04(o j_ SETS Zip Code: 3,f f, Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: IG/ .GOM
from the Owner listed above) State or County License: a41
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION"LIEN LAW INFC)RMATIUN
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 4failto Record a Notice of Commencement may result in your paying twice for
improvements to your ropeNotice of Commencement must be r ed and ted on the jobsite
before t firs inspe ion. tend to obtain financing, consult ' nder r a orney before
comm n n ork rec r ir Notice of Commencement.
Ot
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f
Sigrlature of Owner/Les Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _5:2�: 41)r/.G COUNTY OF _<�I_
The for ging instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi�� y of ��fJGy 20/�by this� �f9ay of �!J 20/�, by
(Name of person acknowledging) (Name of person acknowledging)
(Signatuli a Notary PPuublic-State of Floridf-
a) (Signa£Ore-oNotary Pubrt�c-State o Florida)
Personally Known ✓ OR Produced Identification Personally Known / OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. _ I Commission No. ++
ANN M.GAUMOND I.:=4�"` ANN M.GAUMOND
+= MMISSION I FF 17300-7MY ro
EXPIRES:December 7,2018 ;;. EXPIRES:December 7,2018Ik
Revised 07/15/201 t Bonded Thru Notary Public Underwriters f,; Bonded Thru Notary Public Underwr ters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS