HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d 3 Permit Number: \5
RECER'7-D C''; 03 2016
:J f _ 3
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 Commercial _� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ��S
PROPOSED IIVIPROVEME;NT LOCATION„
Address: 10W S n ce7q, —m fid,
Legal Description: ocimooN4 5bvz4 ObN/.70 ur-IT '{oZ
n, ccrk�o,v S oti 3112—cctS
Property Tax ID#: �s,(� - S(7 ^OOyy. coo— Lot No.
Site Plan Name: Block No.
Project Name: �/� 'Ak7,T'�12
Setbacks Front 1/-r Back: M A' Right Side: PLA- Left Side: N a
DETAILED DESCRIPTION OF WORK
1 _�►� ��G9G8ut!� /o�Ew C(-(r1Tlrv�
CONSTRUCTION INFORMATION U��r✓�
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Additional work toe performedd under this per rt—check a app y:
❑HVAC Gas Tank 0Gas Piping Shutters Ln�,[Windows/Doors
11 Electric 0 Plumbing Sprinklers FIGenerator E] Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 'I-70U Utilities:0_Sewer E]Septic Building Height:
OWNER/LESSEE CONTRALTO R
Name i La(I-Av ties
. Name: 1G .
Address: U s iD 2tf-- O Company: _)Gy56U /IIli✓�l
City: State: Address:
Zip Code: 3/q V-'l Fax: City: SL�� Sta e:
Phone No. (*0)A(S"—8� g Zip Code: 3 y Fax: 2 —27'-1 cZ
E-Mail: Phone No. 19-L- OCRC7
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed-above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTR*U, N LIEN LAW INFfJRMATION
_., �,,x.
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:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I 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 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 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 iFnasttorney
r paying twice for
improvements to/sct
r r/dringyouj-
rty.A Notice of Commencement must be recorded ated on the jobsite
before the first in ' you intend to obtain financing, consult with lend before
com i woNotice ofCommencement
s
14gnaiure of Owner/Le see/Contractor as Agent for Owner Sigliatufe of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST .C!>C147 COUNTY OF
The forg.Ing instru nt was acknowledged before me The forpliin� g instrument was acknowledged before me
thi�� ay of t C�.� 20/ thi��t ay of (_�)C1 20/�o by
(Name of person acknowledging) (Name of person acknowledging)
(Signat f-Notary Public-State ofTlorida) (Signa tureoary Public--State of Florida)
Personally Known OR Produced Identification Personally Known�OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. "'r'P'•. A".&UMOND Commission No. --- - (Seal)
"s
'r ' MY COMMISSION#FF 173907
*: *= � r'v''•. ANN M.OAUMOND
s. EXPIRES:December? 2018 •'15
MYGOMMISSION# F173'.
pc"�.•' Bonded Thru Notary Public Underwriters
EXPIRES:December 7,2018
Revised 07/15/201 ;a;g4e• BondedThruNotaryPublicUnderwriters
11
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