HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Q' C99 1 (a Permit Number:
• REQ
Building Permit Application OCT 2 0 2016
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: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 1�
Legal Description:
Property Tax ID#:=�y 0— 0-0 8-7, 0-0 0 Lot No.
Site Plan Name: Block No.
Project Name: �y �'_d_f 1r
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
itiona wor to e e orme undert ispermit-c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers q Generator a Roof Roof pitch
Total Sq.Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Q'3�S a Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name fk- t Name:
Address: (A 15 LOQ Company: �y� C�fC.
City: S �.l l Cle State: -' Address: WS ��)XA VYld►IrYW_ 10r
Zip Code: Q 52 Fax: City: f0 State:
Phone No. Zip Code: QZL o Fax: 7 877' lel
E-Mail: Phone No. 1 1- ,H44
Fill In fee simple Title Holder on next page(if different E-Mail: Q a kr . Yn
from the Owner listed above) State or County License: t.; 1300 27 01
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN,LAW INFORMATION:
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 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 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 in your paying twice for
improvements to your property.A Notice of Commencement 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 o Notice of Commencement.
s
Signature of0 ne Lesse ontractor as Agent for Owner Signature of Writ ctor/_' rise Holder
STATE OF LORI STATE OF FLORIDA C�
COUNTY OF COUNTY OF J �{ ���- �,( ,l,P
The fA�r�oing instr pept was acknowledge before me The f^or,May
instrum,eept 1w-as acknowledged before me
this."day of 20 UQ—by this 'W day of C1�bcr 20 LLp by
M [,�Nd 'FIQI�MrAn I N Na
(Nam f person acknowledging) (Name of per n acknowledging)
(Signature of Notgh -Stat F rids) (Signature of Notary P lic-State of FI aPersonally KnownOR Produced Identification Personally Known OR Produced Identification
Type of Identificauced Type of Identification Produced
Commission No. F'��
a Publidb)ofFlorida Commission No. r� ery � ��lotary Publi Tate of Florida
Antonia M Paula Antonia M Paula
M;Commission FF 191201 4 �` o M Commission FF 1919ni
TorV%o' E;:pves 1 °oFCLo' Expires 02/27/2019
Revised 07/15/
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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