HomeMy WebLinkAboutBuilding Permit Application SUPRLEMENTAL CONSTR+UCST INN LIENLAW INEORNIATION:
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:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 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
commenci work or recording our Notice of Commencement.
Signati.te of Owner/Lessee/Contractor as A ent for Owner SignatL6e of Contractor License Holder
STATE OF FLORIDAID
STATE OF FLORA
COUNTY OF COUNTY OF
The forgoing instr nt was acknowledged befo The forgoing ins ent was acknowledged before
this day of 2011 bye this day of 20� bye
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(Name of person ac kno [edging) a rw (Name of person acknowl d ' g) `zw
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(Signature of No a Public-State of Florida *„ = (Signature of No a Public-State of Florida) x;,r;
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Personally Known/ OR Produced Identification Personally Known —_. OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014
A{
ll AFPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number: 770L^ 0yy" ? .
MAMM av
- Building Permit Application
CAVO
Planning and Development Services JUN 2 o 201?
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:
P'R0'P®SED INPR01/E(UIENT LO;CATIONd w x .
Address: 14'Z 0 Y-) - �no. l7r IJLXC.SL_
Legal Description:e Jn Q„ Z f),s S �� 3 l_[J , �j qb q (o`t.q AC
01^
PropertyTaxlD#: ��3 � ��1l- �� �-�n --� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _Right Side: 4Jf Left Side:
DETAILED DESCRIPTION OF' ORK:
QX I 1
Y�TA A('TfliLe �S� YO_® C�Yti�nr� 0 f�'Ti)D�
C®NST:RIJCTI®,N IN�F®R11/IATLON:
A itionalworKtobepertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 0 O Utilities: —Sewer _Septic Building Height:
ODUNIER/LESSEE: C®Nl"RAC
Name K� o ML Name: :rS
Address:`7Lva� IIP-. I PS ae ?,(S(o Company:
City 1 rrNo iNA)C+--Lely-Stater Address:
Zip Code:a%ao %g Fax: Cit State L,
Phone No. Zip Codelg o-91 2 Fax:779—LIGtz'' 392
E-Mail: Phone No `77 n
Fill in fee simple Title Holder on next page(if different E-Mail l.'
from the Owner listed above) State or County icense ''"f
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.