HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: t( la����(o Permit Number:
r RECEIV �D DEC 09 2015 R ED
Building Permit Applicati®n
Planning and Development Services
N® 2016
Building and Code Regulation Division PERPM41TTI
2300 Virginia Avenue, Fort Pierce FL 34982 / t. L cie Count , FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ✓ Reside ntiar
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line�d4
PROPOSED IMPROVEMENT LOCATION:
Address: le 10 Y:. 0<- ei 9,1
L
Legal Description: ti
Property Tax ID#: 06-0 - O 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
s
DI`TAILED DESCRIPTION OF WORK
1P4-10v e e7
C FPL lens d
CONSTRUCTION'°INFORMATION
Additiona I work toe e orme un er t is permit-check Tapply:
HVAC LJ Gas Tank 0Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:: SFt.of First Floor:
Cost of Construction:$ (� , d b Do Utilities: Sewer[]Septic Building Height:
01VNERjLESSEE. . ; CONTRACTOR: ,
Name Wc6z,k S� T Q, 6 »92f Name: Gco v A,.,Jv (1,q1 v
Address: / Dom{ ! t7 -S J01-- Company: Car .►_c-,k' a
City: o-Y.Z, T's State:�'L Address: 9 0 44, =
Zip Code: Fax: City: 442�_e �o t-t Zs.� State: i~L
Phone No. Zip Code: Fax:77
E-Mail: Phone No. 6 — 6 5 7
Fill in fee simple Title Holder on next page(if different E-Mail: J C K tq c. 41 I ul G'-P I9-P
from the Owner listed above) State or County License: C 6,[_ 1 S/ 1'7 b
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C `NSTRUCTIQN.LIEN LAW INF(?kMATIQN;
DESIGNER/ENGINEER: _ of 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: _ of 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
commencing work or recording our Notice of Commencement.
� —� s
Signat of Owner/Lessee/Contractor as Agent for Owner Sig ure of Contractor/License Holder
STATE OF FLORIDA% , UESTATE OF FLORIDA
COUNTY OF `=`th,W, )0_) , COUNTY OF 4 1
The for ing instrum n w s acknowledged before me The for oing instrument was acknowledged before me
thisiay of 20 Wby thisr day of��1(��. 20 �by
OnmaiiD 0,Ae&En3 O'n't"W'10
(Name of person acknowledging) (Name of person acknowledging
Q C9
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification
Type of Identification Produced F �-. L: Type of Identification Produced
r ` a (SAOREN S. NIELSE
Commission No. 8,�,, Co mission No. K EN S.
£ Commission k FF 1156 7 .�`:° °� NIELSEN
o? My Commission Expir s =• ._ Commission a FF
1 15637
'0�oma` jul20" � . ission Expires
Revised 07/15/2014 June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS