HomeMy WebLinkAboutBuilding Permit Application 11/01/2016 10:58 3219518735 FLORIDA BREEZE PAGE 03/05
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 4 - (o
Building Permit Application NOV / 1 201
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (272)462-2578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
Property Tax ID#:':3ql Q— 5WO Q ff 5—(2no — ._ Lot No. 1
Site Plan Name: Block No. 42
Project Name:
Setbacks Front _ Back: Right Side: Left Side:
e e r 1 �O r to
it- na wor to e e Orme un er t is permit—C ec a app y:
VAC 11 Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric D Plumbing Sprinklers []Generator Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ 5:1Utilities Sewer Septic Building Height:
5
Name UO Name: .
Address:1 Company:
City: Ir State:_U, Address:. C t'
Zip Code Fax: City; 1R e State:
Phone No. zip Code: � — Fax
E-Mail: Phone No.,-?521—��9
Fill in fee simple Title Holder on next page(if different E-Mail: �' '(YltTX`Tl�_t_:
from the Owner listed above) State or County License:
tf value 0f construction is$7500 or more,a RECORDED Notice of Commencement Is required.
11/01/2016 10:58 3219518735 FLORIDA BREEZE PAGE 04/05
DESIGNER/ENGINEER; Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City. State: City: State:
Zip, Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Address: Address
City: City:
Zip: Phone: Zip:_Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
eCoun makps no representation that is granting a permit will authorize the ermit holder to build the subject structure
sincon ict with any applicable Home Owners Asiociation rules,bylaws oran covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions Which may apply.
in consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,si.gns,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Recor d a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first-inspection. If you intend to obtain financinig, consult with lender or an attorney before
comme;Kin workor recording your Notice of'Commencement.
SiF56—reaT me_r/Mssee/Cont–r1;ct9cas Agent for Owner Signaturi of Contractor/License H der
STATE OF FLO14DA STATE OF FLOWnA
COUNTYCIF r)fe,\J(2,Cd COUNTY OF ')n
Thef Ing Instrument was acKr�10W!ed&4�efore me The forgoing instrument was acknowledged before me
this
(Name of person acknowledging) (Name of person acknowledgingj
($ighaturi offilotary Public-State of Florida) 's,,J (SlignAre of Notary Public-State&f'RoFidaQ
Personally Known OR Produced Identification Personally Known K. OR Produced identification
Type of identification Produced Type of Identification Produced
Commission No.
77-10197 MCCARTHY AM
AIR
ExPIRES July 29.2019
REVIEWS FRO zoyq I ru P'RaIPLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
TAPTE
OMPLETE
INITIALS