HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .9 Permit Number:
Building Permit Application FEB m9 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: Y'
PROPOSED!INPROVEMENT LOC+AxT10'N• 4 {� f < ' :� t rf -> {
Address: 7.�sU'C� aye�(C,�,oucG(r► a��
Legal Description: V-O oi` �(6,te_-) 6� —\J kn-z�
Property Tax ID#: ���,�—1 p ADO('6—0 6'b � Lot No.
Site Plan Name: Block No.
Project Name: Ua �c �}
Setbacks Front Back: Right Side: Left Side:
DETAILEDnDESCRIPTION . 1N.ORK
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CONSTR JFCTIOLN.IWORMATION
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator V-
Roof
Total Sq. Ft of Construction: Wo Sq. Ft.of First Floor: 'Z
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OW,NE LESSEE: CONTRACTOR:
Name arae:�'pp na S -LIC,
Address: ► Yompany:
City: Ykgi Stater Address:
Zip Code: 3401L1g1 Fax: City: 1J State:
Phone No. '77 Z~ 9761-S-7SS Zip Code: -r>ZoL((,* Fax: 772- 3s-03y�
E-Mail: Phone No
Fill in in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County LicenseLGCG OS731 h
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUP4M MENTAL�CONSTRIJCTIOWM'N E rL�A17V INF;O�RMA ION �
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ,ef 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signatur ner/ esseel gear y -Signature of ContT etor/License Holder
STATE OF FLORID '' µ'''` STATE OF FLORIDA ,y,
COUNTY OF Q COUNTY OF T
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The forgoing instru nt was acknowledged before The fo�ing instrum was acknowledged before •' I
this day of n 20 A, byo a this�day of 20by a M. �
X a
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(Name ol person acknowledging) a N;9 (NameOf person acknowledging) 8.
Jam_
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JAII)A'd 11,1- 4 N
(Signature of N Iary Pic-State of FloridaV ( ignature ofYdry Public-State of Vio6daY
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 SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014