HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�• "" RECEIVED FEB 16 2016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 f
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ✓
PERMIT APPLICATION FOR: q{ boo
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Address: 12= TN in CJ("rcVS
Legal Description:--1Witi C I L-0+2 (IAIAG) (OV505- I No-,�))
PropertyTax1D#: a33�J-��� ti C1C3d a- 4�0 "' Lot No.
Site Plan Name: Block No. nl A
Project Name: w-q Y)Wk-
Setbacks Front Back: Right Side: Left Side:
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ftiona war• to a pe orme un er t Es permEt-c ec a t at app y:.�
Mechanical Gas Tank Gas Piping _Shutters ✓Windows/Doors
Electric _Plumbing ^Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: ,Sewer _Septic Building Height:
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Name Name: _^6rqunn�
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Address: IqC60TNinaecks Dr-. Company: o' &cwd d-ha `!ar
City: 5r+-- e!-Cf', State: FL Address: i(05 -romahak)k D/
Zip Code: d3d9L1.5 Fax: nlla City: T�laA 1`�afFjaw i3eac-" State: i"/
Phone No. �`(72� LILo(p-�.1 q Zip Code: 3Z937 Fax: 32-1- 777- 4/23q
E-Mail: Q A Phone No. 772-337-4f4170
Fill in fee simple Title Halder on next page(if different E-Mail: �u{esshccun �� ��az• �a
from the Owner listed above) State or County License: (
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Addrss:eAddress:
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
commRncing work or r9gording your Notice of Commencement.
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Signature of Owner/:Agent/Lessee Signature of..Contractor/License older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �t-P_\,GI rd COUNTY OF �-�,�d
Thef,going instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this m ..(�.day of tQ Yl4__,201�, by this 5 day of '�11(.�_ 20ll�o by
LL( a s
( me o ac k owledging) {NaU0 ',a nowledging)
{ n ry ublic-State of Florida ) {S n e Public-State of Florida)
rso naw •� OR Produced Identification Persona own ✓ OR Produced Identification
Ty of I e ation Produced Type of Identification Produced
r-r� t � � ,, BROOKE SZIGETI
Commission No.11244U55 �+ I) BROOKEMGETl om fission No.��.�Cp�JJ �? ��aI)MYCOMMISSiON8FF2446
MY COMMISSION R FF2�iy5 EXPIRES:June 25,2fl19
to EXPIRES:June 25,2 19 �Rf,�4b` Bonded Thtu Notary publPo Undenv 1
H
ry u env ers
REVIEWS FRONT ZONING' S®UPERVISOR S VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014