HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �f `� Z Permit Number:
5 J ; RECEIVED
0
MAR 14 /016
Building Permit Application Permitting Departmer,
Planning and Development Services
St. Lucie C^ ate+
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:
e
PROPOSED INPROVEMENT"L4CATIbN.
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Address: S&/ HC ten/ c✓� y Li ,
Legal Description:, _%�o of e A+- �'Use
Property Tax ID#: J-11 U Lot No. r
Site Plan Name: ! Block No.
Project Name: 1&-0dZ7 /y-/o &Ale S/-J02. TA/
Setbacks .Front Back: Right Side: Left Side:
DETAILED DESCRIPTIO'OF WORK
CONSTRUCTION INFORIVMATI0N
Additional work to be pertormej un er this permit-check all that appy:
_V VAechanical _Gas Tank —Gas Piping. _Shutters Windows/Doors
_Electric —Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
CSU
Cost of Construction: $ �I e - Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTQR:
-
Name &Z/LL^Cc /16tL.i 4.10,-7-// Name
Address: sly/U /z/C r"NScu'AY er Company: e6 4M P L 4! 7-L 271 �
.City: State: F Address: /5 2-1 7P/q z/,/ L,41,c :e zf
Zip.Code: .3 V q r5 Z Fax: City: J<rt p .r[rr`. Stater
Phone No. 3 D 3 -2-So -3 /(o Zip Code: 33','(,�- Fax:
E-Mail: Phone No 51111,1 -S2
LLIf'valrue
n fee.simple Title Holder on next page(if different E-Mail. > a��= yco<u���: CCIlk Foa,,c�C)i—
"the Owner listed above) State or County,License CA �= y��/oma
of construction is 2500 or more,a RECORDED Notice of Commencement is""required.
SUPPI EMEIVTAL CONSTRUCTION l IENLAW IIVFORIVIATIC}N:
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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for OwnerSignatur,.e of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
( OUNTY OF Sk . Loc _wC1. OUNTY OF S4— L01_.J,e-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this J Lday of�n0n&LCJ,21 20 by this ]`] day of 1�/i,�2GL, 20�by
C', A(-(- 1��y 4 CA,(Z-r
(Na of person acknowledging) (Name of person acknowledgingeln i,
)
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(Signature of Notary Publi - tate of Florida) (Signature of Notary Public- ate of Florida )
Personally Known OR Produced Identifi Personally Known OR Produced Identificat'
Type of Identification � Type of Identification
Produced �J� M
DATE
Produced .�:�- 4'��"°�_
Commission No. (SealCommission No. (Seal) Ko-<
m X73 a>
REVIEWS FRONT ZONING PLANS VEGETATION SEA TURTLE �oCOUNTER REVIEW REVIEW REVIEW REVIEW J-1t
DATE ?'A
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RECEIVED o .=DATE NN�.COMPLETED m
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