HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST
�fB�E' COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
/L12 . 9 /° Permit Number:
RECEW
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Building Permit Application DEC 2 7 2016
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 1111101IEMENT LOCATION
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Address: �7�'n S 0Cori p(- 1133
Legal Description: IC&A 4nL)Nt_S calloc7 UN i r 113-7
UAJ,00 (0/4 262 1 —(/n 7 ,
Property Tax ID#: -3 SS-3S- - r7 g0U -1 Lot No.
Site Plan Name: I,/ANG y Block No.
Project Name:
Setbacks Front N /Y Back: _Right Side: Left Side:�le
DETAILED DESCRIPT10NZF WORK �' h
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CONSTRUCTION INFORMATIONY`1 x � s =s> , N�
itlona I work toe e orme un er t is permit-check a appy:
11HVAC Ei Gas Tank ❑Gas Piping _Shutters Windows/Doors
IIElectric ❑ Plumbing Sprinklers ElGenerator _Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 31(x70 Utilities: _Sewer Septic Building Height:
OWNER/LESSEE' ` ` Y0.
_ CONTRACTOR ' sr.
Name A'4A&S Name: w
Address: -IZ's- (6(JLL. ole- Company: B1.``I14W!Wy'Vj
City: State:�1� Address: �'�?,c) Nly\l 6226YblktL,
Zip Code: Fax: City: S'fi'*&I- State:
Phone No. /02� .�3�7 ~ �`3�t g Zip Code: �k_ gCH Fax: 6012-�7�lLl
E-Mail: Phone No. CJ u
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. 7
SUPPLEMENTAL CONSTRUCTION LIEN LAW 1NFORMAT10N3
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con tlict 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 f ilu to Record a Notice of Commencement may It iXP ling twice for
improvements to your/ong
A N ce of Commencement must be d a n the jobsite
befor h first insp du i end to obtain financing, consul it der rey before
com enci wor or ru Notice of Commencement.
s
Signature of OwrVer/Leselpr1raEtor Agen f r Owner Signature of Contra r/Li nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S1 COUNTY OFA
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thib?�Z day of 1)b!!FZ— 20/�by this�day of 20/�by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu tc-State of Florida) (Signature o" otary Pub' -State of Florida)
Personally Known V---'CR Produced Identification Personally Known-OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No.
ANN M.GAUMOND �'"PK ANN M.GAUMOND
;V �+ MY COMMISSION#FF 173907
MY COMMISSION#FF 173907
oV ecem er7,2018 Notary Revised 07/15/201 $f "'� Bonded Thru Notary Public Underwriters $f,f��'� BondedThmPublic Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS