HomeMy WebLinkAboutBUILDING PERMIT APPLICATION'Ali APPLICABLE INFO MUST BE COME . -D FOR APPLICATION TO BE ACCEPTED
Date: 2 U41 2 { Permit Number: Aj V-� tv y «
Building PerIipi8lication �A_
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Planning and Development Services BY 6 2016
Building and Code Regulation Division St. Lucie county
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ✓ Residential
PERMIT APPLICATION FOR: hyZ'
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Address: �SS�ys T1W\i —I— VOCT ST L.vca 3`[GSZ
Legal Description: J4 t/( i P-
Property Tax ID #: 1 LI Ll -SO1 — `�I CL{ "3d5- - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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moos wor to a pe orme un ert is permit-c ec ,a that -apply:
Llylechanical Tank -Gas Piping}; __ Shutters —Windows/Doors
—Gas
- `, 'i Generator Roof
Electric: _Plumbing Sprinklers:, ' - ,. _
Total Sq Ft of, Construction: i; Sq: Ft. 6f First Floor:
002
Cost'6fC6nstruction:$ Utilities:="•_`Sewer Septic Building Height:
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Name r 12 U Avi 5
Name: CkAe C �AA>4z1�
Address: i 33 W Gti2rg 2L��P i�
Company: XtXr1C� AP4 i u u t i'-t
City:" 0 r Stater
Address: S'f'9 Sw l-eda"4 C4_.
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City: Td'T 1 uc State: �2
Zip Code: 3 Fax:
Phone N
Zip Code: 3`1 (o Fax:
E-Mail:
Phone No �i Z-Zj} _ O 3
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable' MORTGAGE COMPANY: _ Not Applicable
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 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 tfirst inspection. If you intend to obtain financing, r,gnsujt wi lender or an attorney before
commet in¢ work or recocdkm vour Notice of Commencerrt�rit./l
Signature of Owner/ Lessee/Contractor as Agent for Owner
tignature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA -
COUNTY OF
COUNTY OF
The f ing instrument was ack owledged befor=
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The for oing instrument was acknowledged befo $i' '. o;•;
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this.�dayof 20JI by
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this day of �% � /i— . 20/6 by
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(Name of person acknowledging)
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(Name of person acknowledging)
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ignature of o ary Public -State of Flo a)
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Signatur o Notary Public -State f FloridLai
=Personally
Known OR Produced Identificatio
Personally OR Produced Identin
Type of Ide tific
Type of Ide tifica 'o
Produced —
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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