HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .�ay �.\� Permit Number: 1C,Oc Sa
RECER—H JUN 24 7.116
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 �Ao,�' od
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Address: CJ
Legal Description: will ) p I I r V, I'la-S
Property Tax ID#: 3 6 a9, ^ 100 5 -- OO 26 — 000147 Lot No.
Site Plan Name: Block No.
Project Name: AX1tol lox Shorp�S
Setbacks Front Back: Right Side: Left Side:
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Additional work to be nertormed under this permit–c ec all y:
HVAC Gas Tank F]Gas Piping Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ 3 ) q(0- 6 Utilities:cn Sewer 0 Septic Building Height:
Name dlianp Boximincl. Erao-n • Name: i
Address: '7`�I o S•DC"e4'� r. So 7 Company:
City: Tursom State: FL, Addr ' SIE
Zip Code: 3 qq S;? Fax: City:es State:rf A 22
Phone No.� a4&-Ill3L4 Zip Code. Fax:G—IL13-- J�
E-Mail: PhoneL,.
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License: a
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:
im 1 0 1
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
commenci ur Notice of Commencement.
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_Signature of Owner Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLCIIDJ,
COUNTY OF COUNTY OF
Th org ing Inst ent was acknowledge efore me Th ng instru was acknowled before me
t day of 20 �y thy of20y
(Name of person ackno dging) (Name of'person acknowledging)
Ignature of Notary Public tate of Florida) lgnature of Notary Pu ic-Sta lorida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. S (Seal)
„" MELISAARMENTO MELISAARMENTO
= MY COMMISSI
(PIRS.December 28,2016 ` EXPIRES:December 28;2016
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE 7-W_4
INITIALS