HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � �� Permit Number:
, RECE1\ 7D JUL 2 '1 3016
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line '
PROPOSED IMPROVEIVIENT LOCATION:
Address: loqbo -7(2-
Legal Description: 4, N I�JNC5 CoNO o (/N 1 r ' 2 Zug -340
Property Tax ID#: qJ-f 2 —?y Z- co b ' y Lot No.
Site Plan Name: /�,/ /jA-rV/J D Block No.
Project Name: 121 ti r.,0-0/v
Setbacks Front �' Back: A- Right Side:4�_Left Side:
DETAILED OESCRIPI`ION OF WORK
W �N✓��v� �r��'h�c-� I o
t1 o f\ i YY\ do t
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CONSTRUCTION INFORMATION
Additionalwork to be ertormed under this permit-check all L appy:
❑HVAC Gas Tank Gas Piping _Shutters indows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
0
Cost of Construction:$ a� Utilities: _Sewer[]Septic Building Height:
,OWNER LESSEE CONTRAHHC��TOR
Name I ICN ►7o Name: 1�1(G�r140( l nit
Address: L,�VOA- PAe- Company: ajENroj uwciNl.+ M
City: �H X-ON / MY State: Address: 1-7 Zv NW �f;'1�L✓1A'�- (-tw(
Zip Code: // Fax: City: �t-W !/l State:_
Phone Na - b Zip Code: �/u 19y Fax: (O�2-y7YLl
E-Mail: Phone No. ('A
Fill in fee simple Title Holder on next page(if different E-Mail: ��l 'ta.[ Qw��" c-/'4'� •fir
from the Owner listed above) State or County License: r7f"C, f'K-o,84 '3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
INFORMATIf
SUPPLEMENTAL CC}NSTRUCTIQN LIEN LRUti/ ?N
_s. .
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:Y urXillu to ecord a Notice of Commencemen result in your p ing twice for
improvem to your Yrd�i
tice of Commencement must re rded d p d on the jobsite
before t fir i spec oy i end to obtain financing, cons wit lende r ney before
comm ncin k o rec ur Notice of Commencement.
s
_
Signature(of Owner/Lesse gen 44—i "`V Signature Contractor/Lice a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Si COUNTY OFST LJC
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ay of , &," 20/,by this/9t5od'ay of J–LJGY 20/ ,by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signat -of-Notary PubTit-State of Florida)
Personally Known. OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No.
�AUMOND � Y"i ;- ANN M.GAUMOND
4 +: MY 't0. := MY COMfv11SSI0N#FF 173907
11
:;.; it
EXPIRES:December 7,2018 =�,. 'a`-' EXPIRES:December 7,2018
Revised 07/15/2
Bonded Thru Notary Public Underwr tars RF ° '` Banded Th ru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS