HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: /& c2-7
RECEIVED
Building Permit Application SEP 15 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
N1
E ,LOCATION
DAMP E
Address: 7 V6c_J-( C'_6
Legal Description: 06 3 �' 3q- Thc.+_Pgj��r)-Ps�,;. Js �Acwia 6 k 2397n(9
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PropertyqaxlD#: d//
Ir_ J�6 Lot No
Site Plan Name: SO4pt(6-6 ", ke-L, . r Block No.
Project Name:
Setbacks Front- Back: Right Side:. Left Side:
DETAILED
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CONSTRUCTION:INFORMATION
Additional work to be nerformed under this permit-check allt=apply:
E1HVAC Gas Tank FlGas Piping 1 AShutters F]Windows/Doors
11 Electric Plumbing E]Sprinklers MGenerator Roof
Total Sq.Ft of Construction: SFt of First Floor:
Cost of Construction:$ Utilities"n Sewer F]Septic Building Height:
OWNER%LESSEE CONTRA
NameItKa d-tka-b I-e-, (J L Name: c.. r[-C--f-q e62 11.C-q
V . -
Address: inn 64 Company: r (1-C b'Z-,
City: . State:� Address: CO-3 Ecf, trc f.
Zip Code: S Fax: City:-Ff 0/im-c'e, .State-.-Ec-
Phone No. Zip Code: -5 Fax: 7
E-Mail: Phone No.
Fill in fee simple Title Holder on next page if different E-Mail: re U� fed
from the Owner listed above) State or CountAicense: ti
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
90's-1�510_affiffi,
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:
p Address:
ddress:
City City:
Zip:• Phone: Zip: Phone:
1 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 yotmoaying 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
com cin work or recording our Notice of*Commencement.
_ G
ignature of Owner/Agent essee Signature of Contractor/License Holder
STATE OF FLORI STATE OF FLORIDA dt
COUNTY OF COUNTY OF
+ ' The f r oing instru n't w s acknowledged efore me
The forgoing instr ent was acknowledged efore e ;;x,,.•�
this day of 20�by o thisg day of 20�by
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(Name of person acknowledging) d-= (Name of person acknowledging)iF
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(Signature of ryPubl�i - tate of Florida) (Signature of IV
ry Public-State of Florida) a
Personally Known R Produced Identification Personally Known �OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS - FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS