HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Permit Number: r
PONT
Building Permit Application EB m 8 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:
P§0
POSE®,1NPR®'�IUI`ENLt?CA N ' o .
Address: r
Legal Description: ®J /W v
Z-21 �P.G�lk9 lG//�' L
Property Tax ID#: �1301- d(0 005 6 ` 0000 Lot hA No.
YSite Plan Name: � .� y Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
13ETAILED DES RIPTI®N OF ORK � 5*, F f ,. ,. �tlu i-5513
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C®NSTRUCTIOIV INF®RMTi1pN
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Additional work to be pertormea unclertnis permit—check all that appy: vR
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _ _Generator _Roof
Total Sq. Ft of Construction: v __ 1 Sq. Ft.of First Floor:
Cost of Construction: $ e Utilities: —Sewer _Septic Building Height:
21"
OWNER �LESSEEa � � { h� kCONTRACTk
P.'.ktss,.e9�r..
Name Name:
Addr s: f4- W4 KW Company: " 6'vG
City: QZ: State•_ —Ad dress• 6�1',fCK1
Zip Code: 9��&
Fax: City: State:
Phone No. Zip Code: ' Fax:
E-Mail: T. Phone No ?7,;
Fill in fee simple Title Holder on next page (if different E-Mail ON
from the Owner listed above) State or County License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
"Ut!'PLEMENTAL CQNSTRIJCTIQN LItEN LAW INi R1MAT�ICIN:
DESIGNER/ENGINEER: _Not Applicable RTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: ate: City: ate:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDE • _ 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.decd 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-fro.m.,undergoing a full concurrency.'review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen ro'orosand accessdry uses to another nbn-residential use
WARNING TO OWNER:Your failure to Record a Notice of'&mmencement may result in your pIa"`yirig twice for
improvements to your property. A Notice of Gommencement must be recorded and posted din the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an`attornejr before
commenci ork o ord' g your Notice of Commence
Signa re of Own /L see/ en S' nature of Co ra br/Licen e H r
Y
STATE OFFLO D STATE OF FL I
COUNTY OF COUNTY OF '. •,
The for oing instrur� nt was acknowledged befor mom, The f r oing instru nt was acknowledged be
this day of 20 rD by '�N this�day of /� 20& b `
CL = W
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T
OV d RILE v
.� t a
(Name of person ackn w�l�ng) -MEE a (Name of p rson acknowl ing) 9 •• N
0 p— y�[n
UO W�W
6 X� M OE 2�O b�=
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(Signature of tary Pu lic-State o Florid :�= (Signature of tary P is trate o Florida4
Personally Known OR Produced Identificz Personally Known OR Produced Identi jNO,•..,,
Type of Identification Type of Identification
Produced .Produced
Commission-No.;` x �'` (Seal) Commi'ss'ion No. (Seal) o
REVIEWS FRONT ZONIING SUPERVISOR PLANS VEGETATION, SEA TURTLE,. MANGROVE
COUNTER., . .-REVIEW.', ., REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev. 7/2014