HomeMy WebLinkAboutBuilding Permit Application . i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: 19• ,9)!v Permit Number:
RECEIVED
Building Permit Application e
Planning and Development Services DEC 2 7 2016
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial _K_ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRO POSED,INIPROVEMENT LOCATION'
Address: 9 4 t 3 S C c.EFs N :122 I�J
Legal Description: 3S7,14, L41 (;P5LA-WO U1wArGtr FN'4'SL, 1113 t, & 3 Unirr 18
F12o"- I ti r w I W Art 4 At-0 s Li SQL CNS 8� I Z1 AAW ZA
Property Tax ID#: -22c7-c�, Lot No.
Site Plan Name: MA&U-U�; Block No.
Project Name: AAA-CEJ
Setbacks Front '^' �' Back: Right Side: Left Side: A-
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r A-
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16�
TAI,LED DESCRIPTION OF WORKS
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(Tow 'T- 0 ..
CONSTRUCTION INFORMATION
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Additional work to ba �ertormed unclerthIS permit-check a app y:
❑HVAC. Gas Tank Gas Piping _Shutters Windows/Doors
[IElectric ❑ Plumbing Sprinklers ❑Generator _Roof Roof pitch
Total Sq. Ft of Construction: of S Ft.of First Floor:
Cost of Construction:$ gb�`tD — Utilities: _Sewer Septic Building Height:
0.1NNER/LESSEE q K ' £ ;CONTRACTOR..
x. v.
` � ex
Name h/1�(oUl12E. T" AA A-S Name: /urs t� (AJ1^J
Address: 9 CArA*2 ' 0_-k70yo, Company: T / Gu '/✓
City:I its) FA t2 r t C�t-✓� State: CT Address: /-7 L
Zip Code: tj&g I2 Fax: City: ��L✓fititr� // State,
Phone No. 23 Zip Code: 3 N 44 y Fax:
E-Mail: Phone No. &I S—OLDQ c�
Fill in fee simple Title Holder on next page(if different E-Mail: " (3 t9'I-1C0
from the Owner listed above) State or County License: 7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI041.1 E N10iU
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s
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,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO'OWNER:Your it re to cord a Notice of Commencement may result' your paying twice for
improvements to yo r pro . A ice of Commencement must be re cor ed d o d on the jobsite
before the fi in ctio If ou ' end to obtain financing, consult with I d o a ttorney before
commenci o or r r In ur Notice of Commenceme .
Ar
s
Signature o wner/Lessee/Contractor ttgerf fo—r-Ovmer Signature of Contract /Lice se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF JT/�l��l COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thiA2,7 day of 20/�,by thio day of 20 Ze,' by
(Name of person acknowledging) (Name of person acknowledging)
(Signature otary Pub lc-State o lorida) (Signature of Notary Public- tate oT Tlorida)
Personally Known_,OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. .GAUMOND Commission No.
•�`••"�'v" •W P(/•. ANN M.GAUMOND
':' MY COMMISSION#FF 173907 "'
'' •• er 7 201 s MY COMMISSION#FF 173907
:.: :.:
''�of Fa",•' 1.21118
Bonded Thnr Notary Publ'c Underwriters oe December
Bonded Thru Notary Public Underwriters
Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS