HomeMy WebLinkAboutBuilding Permit Application ALL.APPLI(CABLE;INFO MUST BE COMPLETED FOR APPLICATION,TO BE'ACCEPTED'
Date. 1A Permit Number:
RECEI.V7D JUN 2"4� 2016
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 V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line�,,^ � W bob.
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Address:
Legal Description: Saln& ►J 0 11 i1 ras
Property Tax ID#: 3521a — (0'03— 0023 000 Lot No.
Site Plan Name: Block No.
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Project Name: 5QA& I 111i SNC)Y2,S
Setbacks Front Back: Right Side: Left Side:
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Additiona work to be r)ertormed under this permit—check all that appy:
HVAC Gas TankE]Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ o?, aDD.9l Utilities:nSewer Septic Building Height:
Name I?&;a) o Name:
Address: ^71+30 S. QtpWI �il 4.1a S Company: �
City: -TQ-nSQ,n f3pac—k State: FL Address— ` N It r t_.!� ��L—
Zip Code: 54cIS7 Fax: City: 1 Stat .
Phone No. 510' 1 7�v2—Sg(c Zip Code: Fa 3
E-Mail: Phone �D
Fill in fee simple Title Holder on next page ( if different E-Mail:
from the Owner listed above) State or County License: C ��
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required..
DES
IGNERANGINEER: _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.-LucieCounty makes no representation that is granting a permit will authorize the permit 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
commencingwor our Notice of Commencement.
S
_Signature of Owner Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID STATE OF FL O I A r,m /
COUNTY OF COUNTY OF K
Z�rclay
ing ins ment was acknowledg before me The r oing instrument was acknowledge before me
201 y this�day of 20 tL,9 by
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Lh?�' Rn(-�
(Name of person acknowledging) (Name of-person acknowledging)
-
ignature of Notary Pub ic-State o Florida) lgriatu?6 of Notary
`Puublic-State of Florida )
Personally Known OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced p Type of Identification Producedd�c
Commission No. De I on No � h�J (Seal)
MELISA ARM
INTO
MY COMMISSION#EE 855825
EXPIRES: ece
Revised 07/15/2014eonded ThN
Notary Public MY COMMISSION N EE 855825
w EXPIRES:December 28,2016
Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS