HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: Permit Number: �LO LIP • U � `
RECEiVED
LA-WA CLS
• -
Building Permit Application FEB -3 2016
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:
ence-
PR4POSEI I IN, PRQUEMENT IRS ATt4N:
Address: S a l x Ai o r�-h S�S'k-k Skt'eA.+ COPA- A uCL"Fl 3 q 1 c
Legal Description: u c �- P_ic'-Zc' S 9- U n( A� 0 rl2 - 6 1 IG .S 3- S ll 2
OF Lek- '�-i 4 cowl s(I 10k 2,5 CM-,P !C-1 /�ZgS) (0,- 223 -1[200
Property Tax ID#: IL( +0 2- - 12�- 5- OC)O-? Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
13ETALE® DE�SCR
N. ®F WOR+K:
e,G a 2 3C, ee-V- remouc pre. v
CONSTR�tJCTION IN'F®RMATION: '
Additi6nal work to be performed under this permit-c ec 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:$ 00 d Utilities: —Sewer _Septic Building Height:
0V1/NER/LEaS�SE: CONTRAC,1-®R:
NameCkrrs 4c,�plw CJS S ,(� Name:
Address: 3 Xk—j- Ivkk '15, 1. St. Company:
City: (--u r r P State:(--I Address:
Zip Code: 3y 4 y 6 Fax: City: State:
Phone No. 3 I1 ? - 3999 Zip Code: Fax:
E-Mail:CkriSkuphefdav�dSt-eeljL A *ncL J •Ccs 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.
SlJ' PLEMENT'AL CONSTRsUCTlO LIEN LAW IN``OR+MATT �`N;
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: 41Not 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 our Notice of Commencement.
Signature of Owner/Lessee/Agent a „w.N., . Signature of Contractor/License Holder
STATE OF FLORID ?��`�t`�;,r= STA E OF FLORIDA
COUNTY OF '74
^ ` COU OF
o
The forgoing instrum t was acknowledged befor Mee� The forgoing i tr ent as acknowledgefl_before me
this day of 20 by a m?m this day of t 20 & by
cn .<
z i
(Name of person acknowledging (Name of persona nowle ing)
N
(Signature of ary Public-State of F rida) / (Signature of o y Public-State of F id
Personally Kno OR Produced Identification Personally Known OR Produced Id tification
Type of Identific i Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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