HomeMy WebLinkAboutBuilding Permit Application All APPILICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .3 Permit Number:
_ -- Building Permit Application
Planning and Development Services DEC 0 3 2015
Building and Code Regulation Division PERM177ING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address:
Legal Description:
Property Tax ID#: y� 3.0q -33 a/() a Lot No.
Site Plan Name: G f A Block No.
Project Name: 91cle A
Setbacks Front 230 Back:�Right Side: 76 ' Left Side:771
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Additional work to be pertormed 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:$ q,006 ou Utilities: —Sewer —Septic Building Height:
Name Ar es A; Name:
Address: 11-14.1 ldzf.`l'r AeJ Company:
City: 6. 41.el4g State: Address:
Zip Code: ,31 `f S Fax: City: State:
Phone No. 771 .37d 7 Zip Code: Fax:
E-Mail: /otA-AOe.s Co) /fie&o v A Phone No.
Fill in fee simple Title Holder on next 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.
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MORTGAGE
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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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing woA or recordioaqW Notice of Commencement.
Si ature of Owner/Agent Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5"T, LUt COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this'�> day of e. 20 V5 by this day of 20_ by
\'t `> � d15C �0.�
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- tate of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Prod ced.d" fe�afaOn a Personally Known OR Produced Identification
_ _ Type of Identification Prod LID Suisok 016 Type of Identification Produced
�xPises
Commission No. � �' My Go me �on#EE 6 ovary ps11\- Commission No. (Seal)
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o`,, on edZhsou9hNaiio
REVIEWS FRO ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
R 7/2014
ev.