HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: ��.` - I Permit Number: Ism��e �� I 'q9
RECEIVED
Building Permit Application DEC ® ' 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 �/
PERMIT APPLICATION FOR:
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Address:'
Legal Description:
Property Tax ID#: q 32 ' 20-1 00 11 04b Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks . Front Back: Right Side: Left Side:
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S c 1w OL,�Add
itiona wor :to be pe ormed under this permit-c ec all that apply,
_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: $ '�QU• a V Utilities: _Sewer _Septic Building Height:
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ODU° lE�t }LESSE C® T AOR _
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Name 8veld Name: rJ"-'s
Address: Company: rj.r-tis ftJ�l•2r Jd Ly�Sls�
City: r�- P erc_e.. State: Address: J7 D I S. 37
Zip Code: 3 41'1 IN j< Fax: City: F4. P'e'u State:E I
Phone No.(-2 72\ 1 -7 1 " it 7 2.0 Zip Code: 31111 7 Fax:
E-Mail: Phone N�?7L� ?O 1-� 3 U-71
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License 0'6
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
"N' ENT�A�CDNSTR JCTI:ON I CA` wl ORM ►ON ` a S 0-
F MEs.. ,4r
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.
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 firs inspection. If you intend o obtain financing, consult with lender or an attorney before
commencin ork or recording our t ce of Commencement.
Signature of Owner/Agent/Less /Contractor, Signature of Contractor/License_Ho er
STATE OF FLORID STATE OF FLORID
COUNTY OF COUNTY OF
The forgoing instpffent was acknowledged bef The forgoing instrurpiapt was acknowledged before me
� �Z m a
this day of eC 20//� by =o� � this�day of �� 20�y
w_U,2
C • dh J^/V�✓}�J - ' ti 0 U, is
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(Name of person-acknowledging) (Name of person acknowledging)
A.
UC191�X/7 1,40—
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(Signature ofo ar Public-State of Flori ) (Signature of tary Public- tate of l orida ) t
Personally Known ( OR Produced Identification Personally Known OR Produced Iden
Type of Identification Type of IdentificationY4
Produced 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
ev. 7/2014