HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE Y4FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:BY
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St. Luce County / EL
- Building Permit Applicatio pR 16 2016
Planning and Development Services
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:
PROPOSED INPROUEME-NT
LOCATION:
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Address: 9,2S6 e'?eeAAJ ✓�i�h/E� C�I�I S�i1 C�t.Pl� �l•
Legal Description: r4YYAMh( ?.s 1A-(, C�tdO CartP�i`rA P f= o.4r�l c�
�LG�an O2 ? r1J7aP 37s RAn16 Z/j R3 Slourt!`a l7eC/rFr<fraa L'o rlo 2g !� 7
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name: %felTV-6 t Mil-AMAC &A-4
Setbacks Front Back: Right Side: Left Side:
DETrAILED DESCRIPTION O1 WORK:
S
CONSTRUCTION INFORMATION:
Additiona,lworktobepertormedun ert is permit-c ec a t at app y..
_Mechanical Gas Tank Gas Piping "' " Shutters
_Windows/Door's
F I�1
.Electric ,; Plumbing Sprinklers t` _ Generator _ Roof
_ _
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Tota[:Sq;_Ft}of Construction: i� Sq. Ft: de5irsY Floor:
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Cost of Construction: $Gb6 Utilities: _ Sewer _Septic Building Height:1�
OWNER/LESSE
CO RACTOR:
Name rY>4, G e ct^,
Name:
Address: S C-'e.4A 01-'
Company: Secure' (�k5 5;e"IeE5
City: c %, &4eA State:
Address: 695'1 Au --3-
City: 44, W-S State:
Zip Code: 5yjr2 Fax: —
Phone No. 772 229 -3lv 75
Zip Code: -'�` Q; Fa��x)::11 AIA
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail $eCttfQ S eC / ' Spa E1�1 .
State or County License Cv�
from the Owner listed above)
Sfr-fi< 237
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Nam
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
BONDING COMPANY:
Address:
City:
Zip: Phone:
_Not Applicable
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 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
rnmmpnrino wnrk nr rPrnrrlina vnur Nntice of Commencement.
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Signs re, 9 r/ essee ontractor as Agent 1
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Signatu ra 'e
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STATE OF FLORIDA
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STATE OF FLORIDAE;:
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COUNTY C
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COUNTY OF
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The for oing instru ent wo acknowledg d befo
�i day �Y2�h 20M by
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The for oing instr ent was acknowledg bby
this Mayof� 20� by i2.
this of i! .
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(Name of person a mowledging)
(Name of person a tnowle ging)
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(Signature of No Public- State of Florida )
S re of tary Public- State of Flo ida )
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Identification
Personally Kno n OR Produced Identification
Personally Known
OR Produced
Type of Identification n `
Produced C
-
Type of Ides ti n
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
Rev.