HomeMy WebLinkAboutBuilding Permit Application ALL APPLICARLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: Z(0
Date: CXv C-26C
SEP 2 6 2016
RECEIVE[ 1 1) 1
Building Permit Application
Planning and Development Services
Building and,Code Regulation Division
1
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
7
P
EMENT.10CAT- lbM
- b"IMPROV ,
KOPOSE
Address:
Legal Description: _�A4
Property TaxilD#: 00 0 — Lot No. 111—lic,
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Site Plan Name: Block No.
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Project ame:
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Setbacks Front Back: Right Side: Left Side:
DETAILED R
DESCRIPTION QF WORK
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sc,"Me, kwy_� 10C,(,A0V' 1
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CONSTRUCTIOk,I,N FORMATION
Add
--fie—ff- a appy:itional work to DE ormed under this permit—check all
11HVAC Gas Tank ❑Gas Piping —1 Shutters F]Windows/Doors
®Electric Plumbing F❑]Sprinklers Generator Roof Q Roof pitch
Total Sq.K OT Construction: SIn of First Floor:
Cost of Cons truction:$ Utilities: Sewer El Septic Building Height:
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OWNER/LESSEE:...OW
Name
Nme.
m
Address C0pany:
-7,31
city: State: 11 Address:
P
Zip Code: 2Z't C, Fax: Ci
Phone No. Zip Code: Fax: 91-7-7 S
E-Mail: Phone No. f4
Fill in fee simple Title Holder on next page if different E-Mail:
from the owner listed above) State or County License: r;: 3cx)
If value of construction is$2500 or more,a RECORDED Notice of Com encement is required-
SUPPLEMENTA!CONSTRUCTION LIEN LAW 1NFQFtl�JlATI C)N
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Ad am
City: State: Cit4: State:
Zip: Phone: Zi Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable B LADING COMPANY: Not Applicable
Name: I Nae:
Address: AdFress•
City: Ci
Zip: i Phone: Zip Phone:
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I certify that n1l 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 revie�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 undergoing a full concurrency review:room additions,
accessory stru;tures,swimming pools,fences,walls,signs,screen room 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
commencing work or recording our Notice of Commence ent.
s
Signature of Oven r/Lessee/Contractor as Agent for Owner Sign�ture of ontractor/License Holder
STATE OF FLORIDA STA E OF FLORIDA.
COUNTY OF"S-Y, \-vim %P1 CO NTY OF
The for oing iistru ent was acknowledged efore me The f rgoing instrument was acknowledged before me
this""r�r�day of-� 20 1e-by this ' day of e 20 % by
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(Name of person acknowledging) (Nam of person acknowledging)
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(Signature of 14otary Publi - tate of Florida) (Sign ture of Notary P lic-State of Florida)
NSAPersonally Known OR Produced Identification Perso ally Known OR Produced A
Type of Identification Produced ' L_ L_ Type f Identification Produced d c�
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Commission No,. UA.S ticp \N b ti� Com fission No.
Revised 07115!2 •; " .;t. a �
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REVIEWS FRO '^ ING SUPERVISOR PLA S VEGETATION SEA TURTLE MANGROVE
COUNT REVIEW REVIEW REVIE REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS