HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �a 1 51�� Permit Number:
RECEIVTH DEC 15 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 IMPROVEMENT LOCATION:
Address: S7/ ,42 AJAI) L.I✓ S �3 p's-Z
Legal Description: `..il BOV AJ14- VL -7-14 C 00 P C->'1�.•T L-aT Z,lo C3f� 3V
Property Tax ID#: 3J zt, (a ce`f - a I a a— GOO Lot No. Izu
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:_ Right Side: / Left Side: 5�
DETAILED DESCRIPTION OF WORK:
10 LI (17-0 ;
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a appy:
❑HVAC 11 Gas Tank F]Gas Piping _Shutters Q Windows/Doors
Electric ElPlumbing O Sprinklers Q Generator Q Roof Roof pitch
Total Sq. Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ J 00 Utilities: Sewer 0Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name Yl 1-1 t✓ 1 M Name: '3 o t--,s Ir, TNcC S o
Address: 6-7 1 --,-i2>A- fc N ,L,0 Company: SE PtV b.1 N'-F- 1301t_--01C— -S
City: Sly state: Address: '\1-7
Zip Code: 3�'A 9 6--2— Fax: City: q State: 1j::7L-
Phone No. Gy Zip Code: Fax: N P�
E-Mail: Oy ( A- Phone No. 'IZ Z_ - 3-6-2-
Fill
3ZFill in fee simple Title Holder on next page(if different E-Mail: 5 14(::rF to q-t d 4- `PP�►-��.c��
frpm the Qwner listed above) State or County License:CAC 1?fiEVG 3Z
If yralue of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Ap licable
Name: Name:
Address: Address:
City: ate City: State:
Zip: Phone: p: Phone:
FI€E SIMPLE TITLE HOLDER: _No icable NDING COMPANY: Not Applicable
Name: Name:
Address: Address:
C1ty: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.LucieCounty 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 of the granting of this regyested 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 1pnder or an attorney before
commencing work or ref:ording yourNotice mencement.
s
Si u e of Owner e ntFaetoras-Agenffor Owner S' ture of Con
tra ens Holder
TATE OF FLO A ATE OF FLOCOUNTY OF S •�-V e COUNTY OF t
The forgoing instr ment was acknowledged before me The forgoing i strument was acknowledged before me
this day of 20 �by this�5 day of t c 20 by
�Oy1 :S 4c�rP�� ��v, S d►c Ic��
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P ic-State of Florid) (Signature of Notary Pu c-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced L L— ype of Identificat' tdE
�M"Ale GNUS 23 Y COMMI GG 022023
Commission No. EGA ( t1GGU220 mmission No. ��� ► r
` .: •.,, iAy COMM1gSlON 16�2o2U "s°,; P= EXPIRES: eCe 2020 `
'f1' t*: PIKES:Dewm H ;U S, It rs •,' t�g,•° Bonded Tin Notary PUNIC
`oPi Bonded
Revised 07/15/2014 t
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS