HomeMy WebLinkAboutBuilding Permit Application 7
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �_ a) Permit Number:
RECEP.'^D JUN 2 7 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 r,;hAo,�, p�f.
Address:
Legal Description: SQX &_"Do1(w V'd [GqS CMA dy
'9r01 z ( 0aw\,
Property Tax ID#: �jS�a,- �t53� C>ca00- 1000 S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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I = CGT a 39 I—Xva (M6) .IMPACT
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Additional work toe e orme un er t is permit—c ec a appy:
HVAC E] Gas Tank E]Gas Piping Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: 3
$ . 0 7.Y4 Utilities:nSewer []Septic Building Height:
7cAddress:
me__J!)MtS gfgd., Qf2S. �Wict ollnr ShorQ,S Name:
'1436 S. I)MpLn�>. 12 1 B Company.
City: Te-os W I;"(,h State:�L Address:
Zip Code: 34957 Fax: City State.
PhoneNo. -S 7vS2� Zip Code: 5 O Fax:,_czS() -743-23
E-Mail: Phone
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Fill in fee simple Title Holder on next page ( if different E-Mail W
from the Owner listed above) State or County License: c�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 wor dinolh, otice of Commencement.
s
_Signature of Owner Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID C-L, STATE OF FLOCOUNTY OFCOUNTY OF
T r oin ins ent was acknowledge fore me The for oing instrument was acknowledged efore me
th day of 20 this�day of 20 � y
(2 .
(Name of person acknowledging) (Name of person acknowledging)
1
-tsi
gnature of Notary Public-STate of Florida TS119nalure of Notary Publ/ic-State of lorlda )
Personally Known OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced
C Type of Identification Produced
Commission No. J OZJ MELISAAR E� iss n No. �E 0 SSO _
ry MY COMMISSION E i •, MELISA ARMENT�
2016 rr;'
:*= r 28, i-"•' MY COMMISSION k EE 855825
�• :;' EYPIRES:Dece blicUnderxdlers :;
�Pf Fo. Bonded Thru Nota Public UndertiAe
Notary
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS