HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: AG Permit Number:
RECEI JAN 13 2016
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wow 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 INPROVEMENT.LOCATfON .
Address: n
Legal Description: 15- . er,, alv 7-0 —,13Ly'� ,4® .4OT.5 /57 'v D 3R
ot�OR 8�'8 ?6/[7P p ,-5fSo2—aux? 02�'��'--� 9%;
Property Tax ID#: ��/�o�— lnL��'-0�3�v�j—(�C�� Lot No.
Site Plan Name: Block No.
Project Name: ^1 C'OU/J7 � GG���1� ',�4yl>�— U
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
0� /r)>4.e- FRorLt /lo 4sG -70'
9
CONSTRUCTIQN INFORMATION
Additionalworktos.., r.
;
e pertormed under this permit-check all that appy:
—Mechanical —Gas Tank _Gas Piping —Shutters _Windows/Doors
—Electric — lumbing _Sprinklers —Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �� ��� Jv Utilities: Sewer Septic Building Height:
OWN ER/ SSEE LECONTRACTOR:
Name es.9- /fid Name:
Address: �f-�' z?dX 731 Company:
City: &4-1-- S 7 LCe State L- Address:
Zip Code:- = 1���� Fax: City: State:
Phone No. q -"71-30,? S_ Zip Code: Fax:
E-Mail:/ G/7f DitfG 11014f 19-/ • Comet 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY: _ of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _L,-19ot Applicable BONDING COMPANY: _ of 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 topu.r property. A Notice of Commencement must be recorded and posted on the jobsite
before the firs�4ispection. If you intend to obtain financing, consult with lender or an attorney before
commencin, work or recordi our Notice of Commencement.
=Signa a of Owner/Les ee Agen Signature of Contractor/License Holder
S�//ATfE OF FLORIDA STATE OF FLORIDA
COUNTY OF S't. Ly r"\R, COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this k^2) day of7:Sa T\ 20\6 by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary blic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identifickt(o S Personally Known OR Produced Identification
Type of Identi ication �.>'y � �'+�'�cog\e 0 ��o' ,Type of Identification
Produced L b l.. '., aty Pob"c eso�c aj6� ,Produced
My�omm.,ss�on�E as otaty PSsn�.ti
Commission No. Ei4� Z (�8a1) aboo Commission No. (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Re—v—.