HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLMD FOR APPLICATION TO BE ACCEPTED
'Date: �' , Permit Number: '
RECEIVED
• APR 1 i 2016
Building Permit Application itting
Planning and Development Services Per St, Lucie Co Department
untY
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential.
T�Ie_c*�
PERMITTYPE -
PROPOSED IMPROV1E VIEN�T(LOCATION 3`
Address: t— d W V i 0
i
Property Tax ID#: ,J-1 l� —O `V Lot No.
Site Plan Name: Block No.
Pi oject Name: � C.
'DETAILED DESCRIPTION OF WORK. "
i l a _ c�
I
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
lectric _Plumbing —Sprinklers _Generator _Roof Pitch
Total Sq.Ft of Construction: ��11 Sq. Ft.of First Floor:
Cost of Construction:$ ROD V b Utilities: —Sewer _Septic Building Height:
i
OWNER/LESSEE:,. CONTRACTOR -
Name �1 Name: I
Address: A ► Company: n
City: O ► � State:T Address: b
�_ ' ` , jn L
Zip Code: u
Fax:�1 City:�l F State:Phone No. Zip Code: L Fax: /�ff
;E-Mail: Phone No (.
Fill in fee simple Title Holder on next page(.if different E-Mail �)e l5 n U C,5
from the Owner listed above) State or County License EC I . 60
Ifvalue of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
UPPLEMEi�i AL ONSTR�UCI'ION+L(EtV�I #W1f fi�RMATIO
..
a
DESIGNER E GI[11EEI Not Applicable MORTGAGE CO ANY: _Not Applicable rt
Name: Name:
Addr s: 5 KOTGJCt Address:
City: Udd State: L_ City: State:
Zip: Phone — I Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING C P NY: _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 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 mayapply.
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WFEH YOUR LEWER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sig ature of Owner/L /Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAo STATE OF FLORIDA
COUNTYOF oemInO COUNTYOF S�MlmI-C
The forgoing instrurnent was acknowledged,before me The forgoing Instrument was acknowledgeA before me
,this day of -20 by this 1 day of 20 y by
-- . "n � - �.Gbb'It �.n►5h�
Name of person making sta ement. Name of person making statement.
Personally Known OR Produced Identification Personally Known -IC" OR Produced Identification
Type of[den ' tion Type of Identification
Produced Produced
r'alat_
(Signature of Udt��arr,�..,, ublic-State of Florida) (Signature of Nota ublic
Commission No.WV Ndk&*bQcSrateofRmus ommission No.� � '
care Derso AAY Cgnmle�Eoti GG 098857
s MY Commbslon GG Casa � EM*W 04P18MI
REVIEWS FRONT PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.