HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - Jot !, Permit Number: RECL
3
Building Permit Application FEB -9 2016
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 X
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: tn�pw oD�—
Nam
Address:
Legal Description: 'wex5 1j" ( L( F+ Li)', o;. aL- l a
W �9t F:-, O'k �-U-f 33 (-0,.�.5 rCt G ) e-t7rL 3 -W5- W-701 )
Property Tax ID#: J�I l0-.�1 - Ubl �.- 0.60-5 Lot No. "3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
itiona wor to ape orme under this permit-check all that appy:
Mechanical _Gas Tank —Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: C� Sq. Ft.of First Floor:
Cost of Construction:$ o 1 Utilities: _Sewer _Septic' Building Height:
Name SA6-r, Name:�Y�tc � �, to NCC.[ss-L-Q-
Address:3'AL1 -(,,-tt--n W coa Pb Company: C_yl"-,LtIM5 Ut3-r 1)0
City:�M<bn).0 Y-\ State: �-\ Address: 25 LN Sw 1• (1"21%(C- /We--
Zip Code: I a-310 Fax: City:'D-�, S4-koG1 State:_zs�-
Phone No. 3y T 14 Zip Code: ,3L19 -5-5 — Fax: -7
E-Mail: Phone No r)-Y-)/-S 55�
Fill in fee simple Title Holder on next page (if different E-Mail Chats I)1 t, Y1 Ao,r5 4D 0-0Yn0-,,* t`9
from the Owner listed above) State or County License Q-V5 4°L
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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 thepermit 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, Ido 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/Agent/Lessee/Contractor =^'(� Signature of Contractor/License Holder =-
=,:
STATE OF FLOR
or< STATE OF FLORIDA
§
COUNTYOF
V1. COUNTY OF �y
The fo oing instrum t was acknowledged before 0� The fo oing instru ent was acknowledged befo z
this day.of 20 f, by �c=i this day of 2Q& by ���i
C�T 71 0 3T-O
EL
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(Name of person acknowledging) (Name of person acknowledging)-a a6-2&q- 6A- 2�0
�N
/ V
Signatur -f Notary Pub ic-St to of Ridrida) (Signature f Notary Public-State 6f Florida
Personally Known OR Produced Identification Personally Known /OR Produced Identification
Type of Identification 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
ev.7/2014