HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC LE INFO MUST BE COMPLETED FOR APPLICATIO TO BE ACCEPTED
Date: Permit Number:
—/& 69.
• _ ._ . RECEI —D SEP 2 52016
Building Permil 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 Commer ial Residential
PERMIT APPLICATION FOR: To Select from dropbo , click arrow at the end of IinE '
7 7,-, 1 ;.
"PROPOSED IMPROVEMENT LOCATION
Address:
Legal Description: �7T 0�n O/ S
Property Tax ID#: /L ®a I Lot No..i;7a:2
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION O ,,' RW
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&nps
CONSTRUCTION INFORMATION: ' _J
Additional work toe nertormed under this permit—check all t=appy.
HVAC Gas Tank ❑Gas Piping I_Shutters a Windows/Doors
'Electric El Plumbing ❑Sprinklers _Generator Roof Roof pitch
Total Sq.Ft of Construction: S .of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR
„ ..
Name i V d rT Nae: L✓�S
Address: &� Ob�iTEy c� Co pany: C.,
City: H pIrte-c'e State:f- Address: Gra.-Ill
Zip Code:I?qci 11 Fax: City eFc) 6cil Stater'
Phone No. S157 S7 Zip ode: ��6, Fax: ��c�C1'�-77�
E-Mail: Pho aNo. y-/ �ii,
Fill in fee simple Title Holder on next page(if different E-M il: -
from the Owner listed above) Stat or County License: � c �cf
If value of construction is$2500 or more,a RECORDED Notice of Comm ncement is required.
SUPPLEMENTAL CONSTRUCTION LIEN CLAW INFO IVIATION A
DESIGNER/ENGINEER: _Not Applicable IY ORTGAGE COMPANY: _Not Applicable
Name: N me:
Address: A dress:
City: State: Ci y: State:
Zip: Phone: Zi Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING NDING COMPANY: _Not Applicable
Name: N me:
Address: At dress:
City: Ci y:
Zip: Phone: Zi Phone:
I certify that no work or installation has commenced prior to the issua ce of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules bylaws or andpcovenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and revi w your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby a ree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and t.Lucie County Amendments.
The following building permit applications are exempt from undergoin a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen roo s and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Co mencement may result in your paying twice for
improvements to your property.A Notice of Commenceme t must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing consult with lender or an attorney before
commencingwork or recordingour Notice of Commence ent.
s
Signature of 0 ner a see/Contractor as Agent for Owner Signture of Contractor License Holder
STATE OF FLORIDA STA E OF FLORIDA
COUNTY OF 5�• 1-JCS''` CO NTYOF •1.yc�C'
The fo oing instrument as acknowledged before me The r oing instrument was acknowledged before me
thisa day of S• 20 �Gby this day of 7$ 20\_S�_by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary PubW State of Florida) (Sign ture of Notary Pub' -State of Florida)
Personally Known OR Produced Perso ally Known OR Pr94uced Identificati
Type of Identification Produced \E�' 071 0 Type f Identification Produced VNUNS
\ON t10.
Commission No. � eSQ�y\\c��e Com ission No. D ��B ,�,,?c,t�'• ```.
^`�.ouo'i'M'.., ;.lQ\(� Nom ! ::.�.!�h}:',y �'��!�tC�•(] ,•:;C''•.:,.y�iy�,�
Revised 07/15/20
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REVIEWS FRONT ZONING SUPERVISOR PLA S VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS