HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_0l 112-120)(0 Permit Number:
RECEM-1 JAN 12 2016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce TL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click here
P
-ROPOSED-1
Address: r)
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+ 257(bl� 2 YZZ-19 1)
Legal Description:J�)Y"i a,ditCLA A lif
Property Tax ID#:332 8D I COW - QM- Lot No. 2,5
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work tone nerformed underthis permit—check all that apply:
11HVAC Gas Tank E]Gas Piping Shutters Windows/Doors
11 Electric Plumbing OSprinklers OGenerator F]Roof
Total Sq.Ft of Construction: S Ft of First Floor:
Cost of Construction:$
612 Utilities.'n Sewer E]Septic Building Height:
"01NNt ES-SE"t""!
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Name Name:(�SAMLLej
Address:CWp4111rJA1),0
Company.—Ad 0 WA90
City: I I ri State:EL Address: (do I A, r)1rirpe4 0 yeAJI'e—
Zip Code: Fax: City State:,Phone No.-772-Q(op -Z4q 4 Zip Code:.62tt112_ _ Fax: 772-YG'_9-49L[r
E-Mail: Phone No.-7-72-- Q(0_c3_- [(0*0�0
Fill in fee simple Title Holder on next page(if different E-Mail:ad VaAt - 1.1 I's lam A_cd
from the Owner listed above) StaW or Cqunt 10.V10
y License.
_48 7
If value of construction is$2500 or more,a RECORDED Notice of CommencemeiQ is required.
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 work or recording your Notice of Commencement.
tErrature of Owner/Agent/Lessee rglg6ature of contractor/License Holder
STATE OF FLORI A STATE OF FIJ6RIr
COUNTY OF COUNTY i/.,-I I-
The ing instrulnenttvas acknowledged before me The forgoing instrulnent was acknowledged before me
this�Wday`of'...At)Ua!4 F20-EK21by thisl Zf—k-day of%J A-M LAA ni_,,2603.Tby
6muel T_"_�Ivkhg4 6'aMve.l
(Name of person acknowledging) (Name of person acknowledging)
JLe -
(signature of Notary &f F1' Olir;ature-of Nota r,*Lib c-Stat ri.
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C d Profit cation Personally til I
Personally Known .90 pe nally Known
Type of Identificatio d ; S; Type of Identification Produc LuEr
Commission No. Ilk Commission No.
"%ifff W,0111 1 wo
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED