HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: - / Permit Number:
Building Permit Application FB -9 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: To Select from dropbox, click arrow at the end of line
'PROPOSED IMPROVEMENT LoCATION:'
Address: q0q S oac aqDRI>l�sB,1'E/�SEr� QG�Ctf FL 34gS?
Legal Description: 3r. &C, a/ 8 :vi -C L &y,)o CUs`Z/lk) I-I t�f ��S te'
1 326 3-7 Nim 47 S l6 C- LX) SLG S s i�C Ll J-20 9 i f=Tl 7'h dU U ! t 'Nr- Lo
Property Tax ID#: B< 3I 33�F 0063—J&9 -4 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION;OF:WORK
c I CL_
CONSTRUCTION INFORMA-TION
Additional work to be nertormed under this permit check all appy:
HVAC Gas Tank ❑Gas Piping OShutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator _Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
9
Cost of Construction:$ t� , i� 1LI Utilities: _Sewer 0Septic Building Height:
1
OWNER/LESSEE..,: <; -CONTRACTOR:..
Name 6l tH0tjlr M ��ITZ. Name: DC7 w�
Address: q0q S 0_66 ? 1_41V6- Company: ouc_k . Ajr—.
City: 1 EAS n� 866- ( State: rL Address:�It N 0_SA,0,4mnR_f
Zip Code: . �q S� Fax: City: Vit SAwT1,o c_r State:
Phone No. (5,061, 60,1 - l SlO Zip Code: Fax:
E-Mai1:_1_0 V _/_z_0 V6'A17-0/- /4 C--/ Phone No. _ [
Fill in fee simple Title Holder on next page(if different E-Mail: N CqJf'_,gAd. Cor'"(
from the Owner listed above) State or County License: C PLC 1'331dpw
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. /,, �
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5EJP'FLEMENTAL C5'ONSTRUCTION,LIEN LAW INFORMATION
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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.
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Signature wner/Lessee/Contractor as4gentjfor,�Ownermw Signature Con�"'�actor/license Holder
STATE OF FLORID - STATE OF FLORID
COUNTY OF COUNTY OF
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The forgoing instru t was acknowledged befor ; ,.• The fo going instru nt was acknowledged before m ;
this day of 20 by o this day of 20 by
a m�
55
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o AP PV-CDD
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(Name of person acknowledging) w z (Name of person acknowledging) o m;m
S__<
(Signature of . otary Public-State of orida) (Signature of otary Public-State of lorida)
Personally own OR Produced Identification Personally Kno n OR Produced Identificat'
Type of Ide'ntifi ati n �< Type of Iden fica • +
Produced �/, Produced
Commission o. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.712-03.4