HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: J
Building Permit Application
Planning;and Development Services
Building`and Code Regul6tron sion
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 yJ WXJGWS�
Address: 115P., Ntfll eS 31vcd ' 1e6a_,�n C�>ec h ,It. 34cj -7
Legal Description: NCIfl-eS lis'nrO Inc ., A c rcjc�-_sec -inn `F Pay-cc 1
151i� n -0go- 'i�rC_ kx:ZCC=unon
Property Tax ID#: L4-SQa" I-03L* } Lot No.
Site Plan Name:. Kn�) Yl C, RFx,,-'id(--f)C--e- Block No.
Project Name: Kerr r Ir ).'s 10-P-0 e-
Setbacks Front Back: Right Side: Left Side:
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rtiona wor o e e orme un ert �spermit-c ec 'a appy:
HVAC " �Gas Tank Gas Piping _ShuttersWindows/Qoors
Electric ❑Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �(J�3.C� � Utilities:Lj Sewer Septic Building Height:
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Name WVj0j Cir d I iock), K(-nie K� Name: tYn-vki L Q'Pm:-de.
Address: q651 AJW 39+)l Ct Company: Pj2ajCSSiMnIS
City: C-nom I _apd rTIS State!,•i="L Address: -3570 SC IX i C
Zip Code: 3i 0(c)'p Fax: Yl I n City: 64-uo State:FL
Phone No. 254- P�j'9-44(cO Zip Code: Fax: `-I-7d-Q�,•a4(c,�
E-Mail: rirc^le K.:I(Pncvd•Cc 573 Phone No. -7 7a- O&n.o4sq
Fill in fee simple Titiq Holder on next page(if different E-Mail: rev-rni+--,%,pl@Sgprz�<,C�
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED'Notice of Commencement is required.
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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 anttorney before
commencing/work or recording our Notice of Commence nt.
K� .:111=�bsi!i 4Z
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Signature of Own&/Lessee/Contractor as Agent or Sr tur"e of Contracts lcense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF &roWa COUNTY OF
The forgoing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this day of5e �--j 20 J�co by this ZO day.of S(-pism l f_r ,2016 by
(Name of erwri acknowledging (Name of person acknowledging)
7' 2"Lt�o�?n-a/t__#
(Si ature of Notary Publi -St f Florida) (Signature of Nc&ry Public-State of Florida)
r
Personally Known R Produce i ent a�tion Personally Known raFjuced Iden �t �
Type of identification Produced,.. Type of identification Pr '� 4�'4.
- ,,,t,,,,,� NADINE T.GORDON .•
Commission Nol . '''ay A""," 929254
* 4 .�IM,ry PubliESe.�l to of Florida Commission No.
•;My Comm.Expires Aug 29,2018 ,�'t trait.*`s My4Eiyk�s OCI20,?f 1;�
_ IfrinstllYanry
OFF Bonded Through National Notary Assn.
Revised 07 51201'2t%'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS