HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATIO TOBEACCEPTED
Date: J-u Permit Number:
I r:
I Le Coa;K"k RECEI SEP 2 6 29116
Building Permi 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 dropboclick arrow at the end of line
Address: G Lie,
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED WORK
dc'& L)16 16k
kwv S ci, Fi ("(J C"Ob 01
CINSTRUCTIONINFORM
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Additional work to-be nerformed under this permit-cnecK all that apply:
0HVAC f Gas Tank nGas Piping Shutters ❑Windows/Doors
T71 Plumbing Sprinklers Electric, F Generator Roof Roof pitch
Total Sq.Ft of Construction: S .F .of First Floor:
Cost of Constr uction:$ Utilities:cn Sewer _Septic Building Height-
OWNEk/LESSEt'." CO
Name 116f r LY Na e:
C/
C'
Address: Co pany: e-)�r'x
�e,6< C^�nue' c'
City: State: Add ess: UC�tf i c.0 e.
Zip Code: ?Lt6i4f!!� Fax: City: vim) i6 C)-;o State:
Phone No. Zip Code:• 293�11 Fax:
E-Mail: Phone No.
Id
Y.
Fill in fee simple Title Holder on next page if different E-M I
from the Owner listed above) Stat or County License: on()
If value of construction Is$2500 or more,a RECORDED Notice of Commi6ncement is required.
V
SUPPLEMENTAl.CONSTRUCTIQN LIEN LAW INFO IUTATIQN
1 F y
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address•
City: State: C�ty: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: i Not Applicable B LADING COMPANY: Not Applicable
Name: N me:
Address: A dress:
City: Ci
Zip: Phone: �
Zi Phone:
I
I certify that no work or installation has commenced prior to the issual ce of a permit.
St.Lucie County makes no representation that is granting a permit authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association ruies,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Horne 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 pians,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 structures,swimming pools,fences,walls,signs,screen roorrls and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Co I mencement may result in your paying twice for
improvements to your property.A Notice of Commenceme�tit 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 Commencement.
s
Signatu of Own ess ontractor as Agent for Owner Signature of Contractor icense Holder
i
STATE OF FLORIDA STA E OF FLORIDA
COUNTY OF L v c i R_ CO NTY OF -SN.
The forgoing instrument was acknowledged before me The f rgoing instrument was acknowledged before me
this_day of'° ,-, -° 20 Eby this day of -Sl< '20 \G by
ck lo L
(Name of person acknowledging) (Namr of person acknowledging)
OL
—5it �N��Q
(Signature of Notary Pu -State of Florida} (Sign ture of Notary Pu c-State of Florida j
S
Personally Known OR Produced Identific n Perso ally Known OR Produce Identif �E
Type of Identification Produced E- �`' 'L3 Type f Identification Produced( 0
Commission No. +��1 fl' '�r0, Com ission No. ...... ('50i #
Revised 07/15/2014
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REVIEWS FRO �;H•. , G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNT E IEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE V
INITIALS