HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION`TO BE ACCEPTED
Date: ��a1 \� Permit Number.
RECEIVED JUN 2A 2916
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 Residentialy
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line�'�,,��n;;,
A
Address: n
Legal Description:
�lU �
Property Tax ID#: �5aa` �as` C'sc�dd— 0cse) Lot No.
Site Plan Name: _ - n 'hp Block No.
c
Project Name: an& I Ia r SIG(''Q,S
Setbacks Front Back: Right Side: Left Side:
a = CG_T 3(0o z (N5 _TMPACT
I = CGI' 2 3 W FIkQ& (M6) _LMPAGt"
a : C s_T cLppa4 N%,J] (Ma
1 M141. ;.",gl JIM\, I
Additional work to be nertormed un er t is permit-c ec a appy:
HVAC Gas Tank Gas Piping _Shutters indows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator _Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ 3, O S 7.y(0 Utilities:nSewer[]Septic Building Height:
Name SQYI9QS Cir S Name: \
Address: 7'�ID S• �C�O�YI�t'. I O�i) Company:
City: _Twswa CI7 State: FL Address:
Zip Code: 3 495 7 Fax: City: State:El
Phone No. (-1:1%) -,moi 35 r�, Zip Code: Fax:
E-Mail: // Phone No. LA 3—
Fill
-Fill in fee simple Title Holder on'next page (if different E-Mail:6*r
from the Owner listed above) State or County License: C( b5c1�
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 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 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
commencingwo Notice of Commencement.
4Z WC
s
_Signature of Owner Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID ` STATE OF FLORID,
COUNTY OF COUNTY OF (�• 1
T r oing inst was acknowledgff d efore me The fo going instrument was acknowledged before me
do day of 20L th day of 20 by
(Name of person acknowledging) (Name of'person acknowledging)
Signature of Notary 7_011
' State of Florida) tgnature of Notary Pu ic-State of FloridaPersonally Known Produced Identification Personally Known OR Produced Identification
Type of identification ProducedCC Type of Identification Produced
CommissiocQ�-' 2l11; (Seal) *Commission No. alb SS�� S (Seal)
MELISAARM
,..:�iP MELISAARMENTO
a EXPIRES:December 28,2016 =•: :+_
MYGO EE 855825
Revised 07/15/2014 'AR, Po BMW Thru Notary Public Underwriters
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 I I 0(zo
INITIALS