HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10-? Z/ Permit Number:
14- WON i 001100 REcEIV,
Building Permit Applicationt?�
Planning and Development Services AUG 3 0 2016
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
t� t°r
Address: ll? A/ p �S
Legal Description: d1.4wl6Ac/ S'Zyels 690-,x/-�51 h/Ol1S�✓
Property Tax ID#: 3s6 G 7- goof aGO 9 Lot No.
Site Plan Name: II--G�rs.�roJ aSE f , e x� F's�/���� Block No.
Project Name: 1/l�fLfO V,Q AlarS
Setbacks Front i Back: Right Side: Left Side:
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rD;ET ,AILEDQESCRIPTION OF,WORK
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CONSTRUCTION INFORMATION4,ti {w � h yy�ki,; , }� , .� yt, 4yJ
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Additionalworkto e performed and er this permit-check all that appy:
HVAC El Gas Tank Gas Piping _Shutters L__.L Windows/Doors
_Electric El Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ��� 00 Lt.
Utilities: Ll Septic Building Height:
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O.VUNER/LESSEEtCONTRACTO
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Name �s 47 AW-"1,C- Z�/C. Name:
Address: ® Z A49rG1-r49,Z.-1 IA?ov*-r Company: -I-Z'rey ��'e
City: min r,�/VA,.� State:�f%t'� Address: 205-7 ,fig,Wry --I-TYrae r,
Zip Code: Fax: City: �rv' .��r rGCi� State: '/
Phone No. ° g u 1- 10-00 Zip Code: 3&/'75-2- Fax:
E-Mail: Phone No. <--4
Fill in fee simple Title Holder on next page(if different E-Mail: cl-E4-1 e//C 8
from the Owner listed above) State or County License: Eei3a®i9
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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: i 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 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 may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted o bsite
before the first inspection. If ou intend o 'n financing,consul ith lender or an attor ey befo
commencingw or record” our N ice of mencement.
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Signature o r/ essee/ ontractor a ent for nem .4 ' Sign ur f Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
OF COUNTYOF1"o-
COUNTYcc�N
o� a.
The f oing instrum t was acknowledged before � w z The forgoing instru e t was acknowledged befor g�
this j day of 20by �a i5 this day of 2%by amu; Z
a x g x C) e
U
a>_XJl2r Ale P_ � I-t Ale
(Name of person acknowledge g) s.; (Name of person acknowledgin t'�o•.
(Signature of Not Public-State of Florida) (Signature of Notary Ply
ic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
i
i
Commission No. (Seal) Commission No. (Seal)
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS