HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 161 a'&A Permit Number:
RECEIVcD OCT 221015
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Building Permit Application
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{INROUEMENT'LOCATICiN
A
Address: d
Legal Description:
Property Tax ID#: \ 3a3�3� �� Edda-- ��d —� Lot No.
Site Plan Name: �(-' Block No.
Project Name:
Setbacks Front gal Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INF:ORMATIO(V :.
Additional work to be performed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator —Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ b Utilities: j Sewer _Septic Building Height:
OWNER/LESSEE ' €> CONTRAC�"OR tag
Name Name: C\\ S'
Address: O Company:
City: !�7mz \:(�� State: _ Address:
Zip Code: Fax: City: State:
Phone No. a' 7 7 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on ne3A page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
FORMATION
SUPPLEMENTAL CONSTRr�1CTIIA LIEN LAW IN
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Ph ne:
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 permi holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and cove iants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for an 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 r view: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 inen obtain financing, consult with lender or an attorney before
commencing work or recarlaing your Notic of Commencement.
Signature of Owner/Lessee/Agent Signature of Contractor License Holder
STATE OF FLORIDA, STATE OF FLORIDA
COUNTY OF L oc_ Q. COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrumen was acknowledged before me
thisaQ, day of O C+ ,20� by this day of 20_ by
�)i,c.1na`a5 CI'kv.Ae, (
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Notary Pu lic-State of Florida )
Personally Known OR Produce),ld `1'a t°� a Personally Known OR Produced Identification
Type of Identification 6W°' ' Gt� ,skakk• 6 2.p 6 Type of Identification
Produced t' ty P�bti.�v��es��85a�61 Produced_
Commission No. _ i= C° ���Kau°oxo Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014