HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-4
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \ &ky t`\5 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
RECEk':D DEC 18 2015 SCANNED
BY
Building Permit Application St. Lucie County
Commercial K., Residential
PERMIT APPLICATION FOR: C q�.���} 5
Address: J)U
Legal Description:
Property Tax ID i
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
I CONSTRUCTION INFORMATION: ` ya Y.
_Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Windows/Doors
Roof
Building Height:
01NNER/LESS:,EE:
-CONTRACTOR: 8
Name
Name:
Add s:
Company:
City: State:
Zip Code:�M%4%j Fax:
Phone No.
Address:
City.W/ Eralm Qaej�) State //�
Zip Code: t4riA Fax:�IS��i
Phone N
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUP PDLEMENTA GONSTRI1Ci101V
LI,EIV LAW INFOiMATION
t
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_'Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain apermit 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 willauthorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or arld covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any'restHctions 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 concurrencyreview:;room additions,
accessory structures, swimming pools, fences, walls, signs, screerrrooms and accemry,usesto•another-nori-residential use
WARNING TO OWNER: Your failure.to Recdrd•a,N.otice.of Commencement may.-resu(t in you r:pay ng 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
commencingwork or recordingour Notice of Commencement.
Signature of Owner/ Lessee/Agent
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of 20_ by
this _ day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public -State of Florida )
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No: i (Seal)
Commission No. (Seal)
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Rev. 7/ZU14
i
SUPPLEMENTAL.CONSTRUCTION,LIEN LAW INFORMATION:, F_ •" �' "����
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name: Maria Martin/gmley-Hom&Associates
Name: NA
Address: 1e20welwaway
Address:
City: west Palm Beach State: FL
City:
State:
Zip: 33411 Phone: 813-514-9880
Zip: Phone:
_
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name: Pete -Tree Pmperves LLc
Name: NA
Address: 125E Midway Road
Address:
City: Fort Pierce, FL
City:
Zip: 34982 Phone: 561-845-0665
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count 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 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
_ Signature of Owner/ Lessee/Agent
STATE OF FLOR�DA STATE OF FL A
COUNTY OF t?nin, COUNTY OF M
The forgoing ins ment was knowledge before me The forgoing ins ment was acknowledgedpefore me
this day of a 20Eby thisJIt1�1^-day of 201.1—by
dl rk; rr S it I al iJ�err
(Name of person acknowledging) (Name of person acknowledging)
State of Florida ) —( _. tundvf�ary Public- State of Florida)
Personally Known
_OR Produced Identification Personally Known V\,� OR Produced Identifica, tj_Qn�
Type of Identification P �- Type of Identificati c 'rR�uvr Boni
w.'ny ..�ca <, TTGriv-8-rrro-m�..�
' -S_, Commssian FF 123287
. COMMCFF 123287 Commission No. -
Commission No. -- pins May a48
Expir 14, 2018
o 4'++F•.. e;�' °'<�ji�°,t'" Bo A Tnry Trry F6n Insurenee90038SID19
'%FF �:aa Becdetl ilw Truy Fain Nsurznca A0032iT%9 „
Revised 07/15/2014
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FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS