HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: rJ Permit Number:
'< RECEIV':D NOV 15 2016
v 9
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
F
PROP3SED�I�lIPROUEMENT LOCATION Pori h ow-<-owY
Address: lo(or on S o7a9.4 zwy-i- &D f.
Legal Description: c.Q6 ( r c T�� A2., UNC(/ S If�,�L� /,-j
Property Tax ID#: LI�II - "51.-I - 0�2 3 -000 Lot No.
Site Plan Name: � ',q Block No.
Project Name:
Setbacks Front N �' Back: N Right Side: Left Side: /vl L4-
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CQNSTRUCTION`�INFORMATtON
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Additional work toe e Orme under this permit-check a appy: 1411
HVAC Ei Gas Tank []Gas Piping _Shutters LNindows/Doors
F]Electric ❑ Plumbing 11 Sprinklers I Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
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Cost of Construction:$ /D� f00 — Utilities: _Sewer Septic Building Height:
OWNER/LESSEE k ,< , . CONTRACTOR
Name M Name: le, t !�ron✓��.,�N
Address:�/I��p(� s (�(�t: /�2 7oZ Company: ^
City: �US�y %3��3r�f.� State: Address: ('7? ,�, Nw 'r��ICa2/�t_ (,1A,,,,
Zip Code: 3YfJrZ Fax: City: S-f ft ,T— State:�i
Phone No. Zip Code: Lf Soy Fax: (�42- S7yy
E-Mail: Phone No. (1icj2- 0090
Fill in fee simple Title Holder on next page(if different E-Mail:
from the owner listed above) State or County License: (f6 [ / ne y ?
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUpFP,LEMEN� L CaNSTRUCTIQN LIEN tAW-,J, ORMAI"IC}N s
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 co a Notice of Commencement, result in ur pa g twice for
improvements to your property. is Commencement must rec d a post on the jobsite
before the first insp ctio . If y i en o obtain financing, con t with a der an orney before
comme or or r ord' r otice of Commenceme AI
s
Signatureofbwner/Lessee/Contr� as Agent for Owner Sigitature of Contractor Lice se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF e-
=&.21— .<_OCG,E COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this/ '4y&y of )/9!/ 20`e by this/4/ of ���!/ 20`�by
(Name of person acknowledging) (Name of person acknowledging),
(Signature o Notary Public-State of Florida) (Signature o'NTriary Public—State of Florida)
Personally Known L,-,' OR Produced Identification Personally Known L,�OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. "" A 4AUMOND Commission No.
+ pY'P
- s MY COMMISSION N FF 173907 ^i'•. AN M.GAUMOND
EXPIRES:December 7,2018 ?+: e,= MY COMMISSION A FF 173907
��F F�c� Bonded ru o ery u is Jnr ��,:' '
'.of Bonded Thru Notary Public UndenvrRers
Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS