HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
o ' CIS
ED
Building Permit Application
Planning and Development Services JAN 13 2016
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 1NPRQUEME T LOCA lON:
Address: G o S'o Tjv2 w Pi ICE arLL, E\c 12 any
Legal Description:
Property Tax ID#:to 1� U G 3k3 < s/ cxx� �$ Lot No.
Site Plan Name: Block No.
Project Name: SI &Ij
Setbacks Front Back: Right Side: Left Side:
DE AILED DE�SC I�PT1®N OF WORK:
1►uS7c�12L Two (21 L1(rli?S (-t�yiq N 'lv S-rwCL-791DC:� S*AJ
CONSTRUCTIO INFORMATION:
Adaitional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
�Y2lectric _Plumbing _Sprinklers _.Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ q0'0, t0 Utilities: —Sewer —Septic Building Height:
70MERf LE�S`�SEE: CONTRACT®R:
Name KIwG Ouy- Ifiwz4- vl= YC=AcN t4 S VJ,"T�-rSr YName: Q"Fr&V- (W1&dyMl77
Address:CooS a Iva (I, G i--frwO j20 Company: P19S
City: F?- E`K Cc State:rL Address:_S 5,- i3�N Su
Zip Code: 3 y Q S 1 Fax: City: V L"A0 State: i z
Phone No. W /M Zip Code: Fax:
E-Mail: PJ I A Phone No 3-2 l 2 LII 8
Fill in fee simple Title-Holder on next page (if different E-Mail P6 CJ P6-s C�6rPt9e_ ' ctn'
from the Owner listed above) State or County License &—C13W 47-Gq
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUP' LEIUIENTAL CONSTRUCTION LI N LAW INFC)RMATI + N: MEMO
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 inspgction. If you Jgtend to obtain financing, consult with lender or an ttorney before
commencing or r recordin ur Notice of Commencement.
Signatur of wner/Lesse Agent a,� No� Signat a of Cont ctor/License Holder
STATE OF FLORIDA " STATE OF FLORIDA
COUNTY OFCOUNTY OF L� ;<
The for oin instr nt was acknowledged befo �a The for oin instr ent was acknowledged before o
g g o: g g
this�day of 20L by � Wim; this �day of 20/& by
1. rdo- ! m
(Name of person ackno dging) sA (Name of person acknowledi g) a
-. (Off N V C �T Z
cN4
&L&MN
(Signature of NotaV-1.Public-State of Florida ) (Signat e o N t ry Public- tate of Florida) j
Personal) Kno n OR Produced Identification Personally Known OR Produced Identification
Y
Type of Identi ca o Type of Ide is on
Produced C_ , Produced C
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
Rev.