HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ������� Permit Number:
4W RECEIVED DEC 02 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED„IN(P,ROVEME;,lUT LOCATIQN..
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Address:
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Legal Description: P—CGLA✓C A-T-THt /(ZEYenV-C (;o T” 8 oe 37Z3- ?-Iq =
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Property Tax ID#: 3rd - 5b:p -OCA I I - bob- Y Lot No.
Site Plan Name: Block No.
Project Name: 5C tli IGa-
Setbacks Front N/A_ Back: ! Right Side: N Left Side: PP-
bETAILED DESCRIPTION"`OMORK.
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CONSTRUCI'1£3N"INFORMATION:
Additional work to. e performed under this permit-c ec a appy: "
❑_HVAC Gas Tank Gas Piping —Shutters indows/Doors
❑ ak
Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ -70. OOp Utilities:0 Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name (.Oosco (GE 'D0J(o 'C- Name: AA IGLJMV &�VpC,)IN
Address: I(-%3 IE?VC"kyE Ct2 Company: '-JafSflv I'9C*'-a UaGl�n�rt�"�
City: QCL �j- Lu LIC_ State: 4�, - Address: 1-7'U OV"I GE�n� avti
Zip Code: 3 q q Sf, Fax: City: S-I J*, - State:Pt--
Phone No. �33�1 ZSf" -o8�-t9 Zip Code: 4 Ct9!( Fax:_ &q2 _ 7Ytf
E-Mail: Phone No. ?-7Z -(.92
Fill in fee simple Title Holder on next page(if different E-Mail: W.i •ti
from the Owner listed above) State or County License: CG C IN-0 s,(?2q
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
LLSUPPLEMENTAL 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 thepermit 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 IIs,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your fail re o rd a Notice of Commence t may result' your paying twice for
improvements to your pro er o I e of Commencement mu e r cord d osted on the jobsite
before the in ectio . If o t d to obtain financing, cos t h le d o n attorney before
commev'Ing WgrK or r co r o Notice of Commencem t.
1'b(� s
Signature f Owner/Lessee/C actor as Agent for wrier ignature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S-T /,OC/>c COUNTY OF
The forgoing strument was acknowledged before me The forgoin instrument was acknowledged before me
tl i f 40(Z J 20//,by thyof 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature Notary Public-State of-Florida) (Signature o Igotary Public-State o orida)
Personally Known ✓ OR Produced Identification Personally KnownOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No. eal
ANN M.GAUMOND �n`•'�Y"�' ANN M.GAUMOND
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'F oe` BonddlRhruSNoDtaryPblberderwOrtg 'O EXPIRES:December 7,2018
Revised 07/15/2014 ? �� „(„f`,. Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
=INITIALS