HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ` }
Date: 1 % �� Permit Number: \� 0 1 " Ni
RECER D NOV 0 9 2016
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 !i
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATIGN
Address: 14r2 G19-4Z— e 4: b_
Legal Description:
Property Tax ID#: /20! - f6 L ` deo Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
17
DETAILED DESCRIPTION , WORK ' '°
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CON STRUCTIQN,aINFORMATION
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Additionalwork to benertormed. under this permit-check all appy:
M 0 HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing ❑Sprinklers E Generator 1:1 Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �J �0 Utilities:Sewer F]Septic Building Height:
OWNER/LESSEE tip' CONTRACTOR x
Name Ly''F 4-1 Name:
Address: 1 ;� t r4ZI df Company:
City: ie('Cs<"_ State: L Addres D sGJ LDS Gly
Zip Code: Fax: City: % ucLL State:�Z
Phone No. 5-/ 27-`912 2 Zip Code: ��9_�'� Fax:
E-Mail: Phone No. 72oL-
Fill in fee simple Title Holder on next page(if different E-Mail: ,��/1�/ �l ® cJ�ic�0
from the Owner listed above) State or County License: (%W_S72R
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
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r
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
commencirt4work or recording o Notice of mencement.
6/ s
_Signa a of Owner/Lessee/Agent Signatur of Contractor/License Hol
STATE OF FLORI A STATE OF FLORIDA
COUNTY O1 COUNTY OF cS/ ✓�c�
The forgoing instrpo enwas acknowledged efore me
k J/
this�day of The forgoing instrument was acknowledged before me
1V 0 20 by this A day of /VOt"Ll-1 ,ez .20 `- by
(Name of person acknowledging (Name of erson acknowled in ••'•��°* MY COMMISSION#FF 094208
///��� PIRES:April 5,2018
^ /, sr,� o cF T Budget Notary Services
(Signature of Notary Publi -State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known Z, OR Produced Identification
Type of Identification Produced 1. L T of Identification Produced .2 CAROL WEAGLE
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Commission No. ��� eal). DEANNA�IEGNp �m ission No. *M' .-e
1r S:A ri15,2018
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COMMISSION#6G X20 BDndedBudget Notary Services
C. 's*'_ EXPIRES:December 18 eNmters
i+�fOl'
_.00Sanded
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS