HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE.COMPLETED FOR.APPLICATIONJG BE ACCEPTED u
Date: �P .��:. �O Permit Number. �Co,OG� S 11
AIM RkCEl':-D JUN 241016
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 ,��G;�y poo
Address:
Legal Description: Say&—Da ltax V,.I lQ.S
Property Tax ID#: _2�5aa <) — Cy0 —� Lot No.
Site Plan Name: \ Block No.
Project Name: -Sa)ncL 1Vol lam- Shores
Setbacks Front Back: Right Side: Left Side:
1 111 �.,' ® �,
3
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Fill 200 S H C G ii st)
1
Pill c A*Qd,l i C ruszst)
. = PGT Zoo S M 15�
Additional workto a er orme under this permit—c ec .a !Shutters
pp y:
E1HVAC Gas Tank E]Gas Piping _ Q Windows/Doors
Electric 0 Plumbing Sprinklers El Generator 1:1 Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 1, d n1 3 .3 Utilities: Sewer Septic Building Height:
Will I
Name M i'G } TtJJ I.Q VY,QAA Name:
Address: l q3DS .l7CQQ,41��: (D I [3 Company.
City: TQd su-i &wck State: I_L. Address: l� 2 �
Zip Code: 3`{9 5 7 Fax: City:
State:(:-,I
Phone No. <'?721 2 12—'����Q Zip Code: Fax:5n1 "7L1�-23a2
E-Mail: Phone No.so\ --7146 —
Fill in fee simple Title Holder on next page( if different E-Mail:�i
from the Owner listed above) State or County License: (-',ti lk56Fvt
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 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
commencing work or r otice of Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FL RID _ STATE OF F
COUNTY OF LLORI \
V l COUNTY OF 1
Th r ing instr nt was acknowledge� �,a�Q re me The forgoing instrument was acknowled ed before me
this day of 20 Bw this day of 20�by
N.-
(Name of person acknowledging) (Name of'person acknowledging)
0 0 1� C� 0 V-M 6 1�±� —
( ignature o Notary Pylblic-S to of Florida) ignature of Notary`Public-State of Florida )
Personally Known OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.!E ( Commission No. S ZS (Seal)
MELISA ENTO
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:g EXPIRES:December 28,2016
�,p f 1yR` Bonded Thru Notary Public Underwriters
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MY COMMISSION R EE 855825
Revised 07/15/2014EXPIRES:December 28,2018
Bonded Thru Notary Public Under iters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE /
COMPLETE
INITIALS