HomeMy WebLinkAboutBuilding Permit Application 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATIOlil TO BE ACCEPTED
Date:
Perm it Number:
,s:—Ta-] RECEIVED SE) 2 6 2016
WNNEMO� Building Permit 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 Cornmerd 1'al Residential
PERMIT APPLICATION FOR: To Select from dropbox� click arrow at the end of line
,PR0PdS'ED.IMPROVEMENT'LO
LOCATION;:,
Address: R60 t>uk3' [ 00vi
Legal Description- 1'0�
...... ..........
Property Tax ID#: Lot No. -2-
Site Plan Name: Block No.—
Project Name:
Setbacks Front Back: Right Side: Left Side:
E R PTION-OF 0 K-
Ce
L0 6-CA. 4
;CONSTRUCTIOWINFOW I N,:' . ....
Additional work to be neFformed under this permit–cTieck all=apply:
11HVAC Gas Tank FGas Piping to—Shutters ❑Windows/Doors
IgElectric 0 Plumbing OSprinklers Generator E!Roof Roof pitch
Total Sq.Ft of Construction: S F .of First Floor:
Cost of Construction:$ Utilities: Sewer F]Septic Building Height:
TRACTORCCl '
'LESSE�:'
,OW—NER/
Name Na e: -s
Address: vi Co pany: C-
City: State: Add ess:
Zip Code- &'I ci J-1 C-, Fax: city: ye';i7), State:
Phone No.)- Zip ode: -?;g Fax:
0
E-Mail: Pho e No. 17
0 -t
Fill in fee simple Title Holder on next page if different E-M il:
I
from the owner listed above) Stat or County License:
If value of construction Is$2500 or more,a RECORDED Notice of Com�ce ent is required.
SUPPLEMENTAL CONSTRUCTION LIEN'LAW INFO N1AT[ON
DESIGNER/ENGINEER: _Not Applicable ORTGAGE COMPANY: _Not Applicable
Name: N me:
Address: A dress:
City: State: C ty: State:
Zip: Phone: Zi Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable El !DING COMPANY: Not Applicable
Name: N me:
Address: A dress•
City: Ci
Zip: Phone: Zi Phone:
I certify that no work or installation has commenced prior to the issua ice of a permit.
St.Lucie County makes no representation that is granting a permit will authorize thepermit 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 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 Con imencement may result in your paying twice for
improvements to your property.A Notice of Commencernei it 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 Commencerr ent.
s
Signature of Owner/Lessee/Contractor as Agent for Owner Sign ture of Contractor/License Holder /
STATE OF FLORIDA STA E OF FLORIDA ,
COUNTY OF -31- t-'�� � � CO NTY OF ``5 r- -X-%3c,
The forgoing instrument was acknowledg d efore me The f rgoing instrument was acknowledged before me
this�� day of 20��by this �vday of 5 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary lic-State of Florida} (Sign ture of Notary Pu I c-State of Florida)
Personally Known OR Produced Id ntification so ally Known OR Produced Identification
Type of Identification Produced -, L T f Identification Produced t
23
Commission No. �J� 1�D au�Nt�` �N�'O�p OCo. fission No. ��� 1 ����` e COMMISSION#GGO 70
�Mt1\SS10��t�6 a te. iR'' 1 I. SPIRES:December Un Nntets I
";or.M: M�C ES 0 pip\\cin a �:; � Notary�bfic
Revised 07/15/2014 _= epPdaaN l p,
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REVIEWS FRONT ZONING SUPERVISOR PLAN VEGETATION SEATURTLE MANGROVE
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DATE
COMPLETE
INITIALS