HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 0
Date: '1 tJ (0Permit Number:��P
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RECEIVED
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Building Permit Application
AUG 10 2016
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
PROPQSED.IMPROUEMENT LOCATIC?N H ifi
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Address: to ew S 006"
Legal Description: :Jjld L� �l% CON-00 dNe Ot`kS G-I -{-y� G-� U,t'.,Ir_�-
-111I/ " 3c:2 - l'�"12 IT.S Y&0/ st' � ()� ��(/uIHOK/ 6eez ' c.1l__r_/
Property Tax ID#: 415 It -Bo( -mol -Ooo ' -7 Lot No.
Site Plan Name: -1 i4 -. ye� CW8 Block No.
Project Name: TL)VbTf�6, (zCLT CXAA
Setbacks Front N- Back: N�a-- Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CO TRUcTIOU INFORNfATICIN
Additional work toe e orme under this permit-check a appy:
HVAC Ei Gas Tank ❑Gas Piping _Shutters Windows oors
Electric ❑ Plumbing U Sprinklers E Generator _Roof
Total Sq. Ft of Construct`ioon: S Ft.of First Floor:
6 QD
Cost of Construction:$(- "_a.� 2•oc� Utilities:cnSewer Septic Building Height:
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:OWNER/LESSEE MINIACTQR
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Name -_T_QitTLE 12.EE2 4:�ww l (NL Name: (G/ 114)
Address: to w S' Y)jf,62 n) /72 Company: / W
City::(:T 'V 13eA,1 :,4 State: V1- Address: �C Vkl
Zip Code:i Fax: City: C /�� // State:��
Phone No.1 2� 17 6 17 T& Zip Code: t'(Ct� Fax: ��7 Ley
E-Mail: I Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: A4(`al4i LL 6eGC>_-;)Wf C9 y.4 .644-
from the Owner listed above) State or County License: 6,e"
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPEM`ENTAL CONSTRl1CT10N LI,EN:LAW (NFC}RMATION
DESIGNER/,ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: I Phone: Zip: Phone:
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I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Cou ty 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 ma result in your paying twice for
improvements to vptipc
y. tice of Commencement must b r rde a p t on the jobsite
before the first inend to obtain financing, cons len r ra rney before
commencin or ur Notice of Commencemen .
5
_Signature of Owner/Less Agent Signature of Contractok/Litgfise Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -S'- I_L2rl�_ COUNTY OF _57— I_UG/,
The forgoing instrument was acknowledged before me The forgot tt 9 instrument was acknowledged before me
thg7���day of LJG 201�by thiz�u�y of J UL 1/ 20/6 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature-of Notary Public-State o-f—Fforida) (Signatur otary Public---State of Florida)
Personally Known��OR Produced Identification Personally Known�OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Se Commission No. Seal
=osY°eye, ANN M.GAUMOND Y"Y ANN M,GAUMOND
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EXPIRES:December 7,2018 ';, EXPIRES:December 7,2018
Revised 7/15/2014 of ftBanded Thru Notary Public Unde wrriers pfQ°' Bonded
Th.
Notary Public
Undervrt tern
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REVIEWS, FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
INITIALS"
MPTE