HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:N6
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"f RECEIV7D FEB 09 2016
® Building Permit Application
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: J�cTt2
Address: i- CU2�c) -7 1flcAce
Legal Description:
PropertyTaxlD#: � \q�SSd�OOy I 4a�"S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalwork to be performed 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: /0z O® Sq.-Ft. of First Floor:
Cost of Construction:$ o 0 Utilities: _Sewer _Septic Building Height:
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Name 04!!�Y .S•r.A 100-f b Name: /��
Address: �S� S_C �reir� �eryYa-ems Company: /c;r
City: S_ C- State: L Address: fiAl<e- t:
Zip Code: 3119603 Fax: City: �. S . L State: F-L
Phone No. 7?.;?- -J'?7 - 31,F-S'— Zip Code: .3 V 9 T;2- Fax:
E-Mail: Phone No Re?Y -C--3at 6
Fill in fee simple Title Holder on next page(if different E-Mail-'T-�,A(2- q o /acA I c--I
from the Owner listed above) State or County License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
N� ,QNr4W A �� M �- f
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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signa of 0 Les gent Si re of Contra i,cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF Sk.
The for oing instrumeftt was acknowledged before me The forgoing instrum nt was acknowledged before me
this day of 1 20%G by this '�N day of 2046 by
�aC vs
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notar Public-State of Florida)
Personally Known OR Produc oAn
Personally Knowr�5.� ORrPf6dr�Ced"Id'elfi�i rrcafionn
Type of Identification i pEpNNA state�o Type of Identifieatior Pia,,; DEANNA GIVE 5
Produced ��., c5�,_4sr,�pubt�c" Dec 1Produced ° `�? Notary Public State of Florida
{. �•, rQ Expires y sDec 16,2016
�o �ommtse� oalNoCommission Nod <oD mmission#EE 858761
Commission No, ��� '
q Through NatEo @;Qary Assn.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED
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