HomeMy WebLinkAboutBuilding Permit Application Xt APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Aa Permit Number: I(,bG, 0 5a0
RECEIVED JUIN 24 1296
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
PERMayI,T APPLICATION FOR: To Select from dropbox, click arrow at the end of line W;v4zw Od
Address: of
Legal Description: (3afl(Q b0 I 1 QA_ V;11125 CO-14 CIO
Property Tax ID#: Cb Lot No.
Site Plan Name: Block No.
Project Name: 6 (U1(�L I)O QN� _(�6t)Mg
Setbacks Front Back: Right Side: Left Side:
a - PGT zoo SH
= PGT eP!4"dImLdI
l = PG-T Zoo S H {S)
Additional work to be Dertormed under this permit—check all h appy:
HVAC Gas Tank []Gas Piping In Shutters 2rwindows/Doors
Electric ❑ Plumbing 1:1Sprinklers ❑Generator F Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ I , 2A3,24 UtilitiesInSewer FISeptic Building Height:
Name a ri 6 C 09-a. MC C "tGk200 Name:
Address: 7 O t^, IrJ C. Company: (J� ��"�� IV��
City: �Q,C1 State: L. Address: K-- OR— 'C-e
-
Zip Code: .3 (R:57 Fax: City: State:L-
Phone No._ _ (.S(ol (v q L4 S7�y Zip Code: L� Fax:
E-Mail: Phone No. ILA?-)
Fill in fee simple Title Holder on next page ( if different E-Mail: N\
from the Owner listed above) State or County License: Use
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
rNa
SIGNER/ENGINEER: Not-Applicable. MORTGAGE COMPANY: _Not Applicable
me: Name:
dress: 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
commencing work or recording our Notice of Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORID ' n _ _
COUNTY OF COUNTY OF c�UV
T r oing ins ent was cknowledge before me The r oing instrum n as ac nowledge before me
ti day of 20 I ky t ' day of 20 by
(Name of person acknowledging) (Name person acknowledging)
Signature of Notary Public-State of Florida) a of otary70R
ic-State of Florida)
Personally Known OR Produced Identification Personally Known Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No (Seal) Commission No.EZMEZ,$ (Seal
MELISAARMENTO my MMIJSASSIONON#EE0EEO
854 i
M4 CO EXPIRES:December 28,2 6
Revised 07/15/2014 EXPIRES:December 28,2016y.
%' oe• Bonded Thru Notary Public Undm dler; ccnded Ttw Notary Public Und en;
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ���
COMPLETE
INITIALS