HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Date: A, Permit Number: /s �"/•V le,y
awl
RECEIVE®
Building Permit Application SEP /9 2015
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 I/
PERMIT APPLICATION FOR: &,In
Q .
Address: W ) A/T'Q-V
Legal Description: t d46e-W(Y0C PtiY t(w,/ /I .6 j K b ,
h'P/�a/U✓ q___ 0 14 / )9Y' X53.3 4'0
Property Tax ID#: / 3 6 l L6 13 —0 /# — a. a 0Lot No.
Site Plan Name: Block No.
Project Name: �J CJS
Setbacks Front Back: Right Side: Left Side:
!7ic oF'. !-fro -1 p P�O,oz�-i`,y L1h c w�'7'ti
.. — 7/ TO. lac%-���t^t�:n e. (vr" ctncl 40 gtj/,
R/� 6 Q c.- L,'rn ti . 7_4e H CA n c( q 0 7/ /u ray u n d
Additional work to be pertormed un d e t is permit-check 5111tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: 7S Sq. Ft.of First Floor:
V o v
Cost'of Construction..$ O j - Utilities: —Sewer —Septic Building Height:
Name �Y r l— Name: C- d
Address: .2 &a-�( Company: all We, r
City: E:±. pi"2r State: Address: l (� yiI o b( 6l✓✓ 7—
Zip Code: ✓� Fax: City: State:
Phone No.77V S✓ )'7/ G Zip Code:_3!k!2:1 3 Fax: 77.:7-8
E-Mail: Phone No. 7 d
Fill in fee simple Title Holder on next page(if different E-Mail: ,p�-f
from the Owner listed above) State or County License:
Ef
of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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.
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 inspectiori. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORJDtk '
COUNTY OF s�'. L pc�� COUNTY OF L tee %R
The forgoing instrument was acknowledged before.me The forgoing instrumenj was acknowledge before me
this do day of 'Se" WAS by this l 4 day of 51t 20_a by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary blic-State of Florida) s (Signature of Notary Pu c-State of Florida)..
- NP��VENo`
Personally Known ORP ed Qb� ifib ���6,��, Personally Known ' b@�I�c � Florida
Type of Identification Pr � � �-�xaaes a5 Type of Identification odu�r6t b���
°e Coln S\oP ,No' y COMM. X E 85876
Commission No. ? '"My GQ� (),q Na" Commission No. MY Co ``�Na ana Volaty A"
ed Thcou1 ter^L - '
Bond y
REVIEWS FRON ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014