HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:J 2-��' Permit Number: q
•
RECEIVED
- - Building Permit Application
Planning and Development Services DEC 2 12016
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Reside&Mille c u L
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION".ION �c
Address. 3/72 lVGv J06r_ ` 5,e
Legal Description: VVIo1e Gy�1/e�s S Lo7Z g' �or 2S`1�0 -/(0 .3/6S
Property Tax ID#: /-oo /Z -OOP - Lot No.
Site Plan Name: e//11l4-r, �7 r-/i Block No.
Project Name: t e_rc Y:q.lc-h
Setbacks Front Back: Right Side: Left Side:
DETAILED,DESCRIPTION OF WORK
/?aMeW16 LrS /`oA 7: NS a4 a-m-cl5� S f/ C !�• n-�
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-� zoz&ti I'CONSTRUCTION INFORMATION:
Additional work to be nerformedunder t is permit-check all appy:
HVAC l_I Gas Tank ®Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing OSprinklers F]Generator _Roof
Total Sq. Ft of Construction:'51ko S . Ft.of First Floor:
Cost of Construction:$ 02 ♦ �Do ��„” Utilities:i Sewer F]Septic Building Height:
OWNER/LESSEE":, CONTRACTOR..
Name qW lar Name: O&S7 //4CP„S I�,,-1o..,.T'
Address: 31 79 /t/w Company:/,40
City: ”142 State:le Addres .S`�s:39278' T10e_
Zip Code: o Fax: /` City:/7sZ., e48 State: 6
Phone No. '779 99-7 4$/2 Zip Code:3q
56511 Fax:
E-Mail: Phone No. -,7.;L-
Fill in fee simple Title Holder on next page(if different E-Mail: &c-4 r4^roo- Amey cGet?la
from the Owner listed above) State or County License: O�C C>z%75!a 7
If value 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 Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE BOLDER: _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 apermit 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 ' bsite
before the first inspection. If you intend to obtain financinpfonsu with lender or an attorney be e
commencing work or recording our Notice of Commenc ni
s
_Signature of Owner/Lessee/Agent Signature of Contractor/LiceW Holder
STATE OY FLORIDAFLORIDA
s��` �-4 c/ r COUNTY OF
COUNTOF The for oing instrument was knowledged fore me The for oing instrument was acknowledged efore me
this -day of�c e.*-, 20 J�y this day of P&C+era j4- ,20 f by
(Name of person acknowledging) (Name of person ac nowledging)
(SignKure of Notary Public-State of Florida) (Si nature of Notary Public-State o orida)
Personally Known �"roduced I �c®mf PN baa Personally Known AOR Produced Ide t' nro,
Type of Identification Produced `l CP �a�e°� 20� Type of Identification Produced K�CP kake° 2p18
,,,uu,,,, ota�`J Q�b yp. es PP 01g083 s�.
Commission No. ,``ay P�B�,�, N FF ps
of>� °# No�aH Commission No.
►o My r°mmtoU9hNai�o�a1 __` i s G°mmto�9hNaiw°a�
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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