HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: < '�' J �° Permit Number:
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.a RECEIVED
Building Permit Application JUL 2 9 2016
Planning and Development Services
Building and d Code Regulation Division
2300 Virgiqlio Avenue, Fort Pierce FL 34982
Phone: (7i 2)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
:PROPOSED IMPROVEMENT LOCATION
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Address: q(9 S Oma v►Zt
t/>V 1809
Legal Description: 'r r&ING,"SS of f-kJrG(4,j fOr-) SSL *j0 or-t T` S
0a 3s6s -u24
Property Tax ID#: UAQ - 017Ii -tom- I Lot No.
Site Plan Name: �'A-S1 LQ i0Qj L.aS Block No.
Project Name: u P00 LD 5
Setbacks Front N/y Back: ^' Right Side: Left Side: N
DETAILED DESCRIPTION{OF WORK
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Pepv� qS(,iowie 61^s
CONSTRUCTION-INFORIUTATIQN
Additionalwork to be nerformed under this permit-check all appy:
�HV4C Gas TankGas Piping Shutters Windows/Doors
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Electric ❑Plumbing Sprinklers E Generator D Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Col struction:$ �?7,IOo r Utilities: Sewer Septic Building Height:
OWNER%LESSEE ;:CONTRACTOR ,,
,
Name I LD fjou 1,05 Name: c G ,J
Address: 14q 7ft-NAIr Company: f Y19-4
City: 6{q�#Ubbd i State: Address: lizoE
Zip Code: 0-7q A0 Fax: City: S-f vA-hr— —State: r(.�
Phone No! dw - 3_ r) Zip Code: 2yq�'y Fax: 11 -L _00q,0E-Mail: Phone No. /��j2 -97YY
Fill in fee simple Title Holder on next page(if different E-Mail: 1r G �.> G/i,✓ G%/ p, cctn.
from the Owner listed above) State or County License: �, [ f�O�K 3-7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION M
aur
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: I 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:
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I certify thatno work or installation has commenced prior to the issuance of a permit.
St.Lucie Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in cdnfIict 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 consideratIion 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 tceRecord a Notice of Commencement mr suit.n y r eying twice for
improvements to your pro rt . otice of Commencement must be 5;n
ed d o ed on the jobsite
before the fi in ectio If tend to obtain financing, consu i o rney before
commen or r or I ur Notice of Commencement
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SknAre of Owner/Lesse Agent 07� Signature of Contractor/ cense Holder
STATE OFIFLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF __<3
The forP�J�J'Ig ins tru ent was acknowledged before me The forgoing instrument was acknowledged before me
thi,, y of I/ 20L�by thi��Z�giy of y 20/,/ by
(Name of person acknowledging) (Name of person acknowledging)
(Signatu otary Public-State of Florida) (Sign atA�Notary Public-State of Florida)
Personally Known_L,--,"/ OR Produced Identification Personally Known r/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No.
t;o.,�Y°Ng•, ANN M.GAUMOND ,poi^pY"r ANN M.GAUMOND
:+: += MY COMMISSION
ya EXPIRES:December 7,2018
Revised 07/15/2014 yr• EXPIRES:December 7,2018 '-;F of d`' Bonded Thru Notary Public Underwriters
;pF °.` Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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