HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l S Permit Number: ' O o1
RECEI`.,':D FEB 2 62016
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:
PROPOSED INPROVE MENT:LOCATION,
M
Address: 550% 66,rnc_e.l AueALLc_ si . -PF e Qe -��d 3 95
Legal Description:
Property Tax ID#: 36 , QSOa�— dCJO—CD Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF 1lVORK; `
!Fti�6_ ke be 00 1,2 0A-CA cpkcp.9b bar iL c,4 C cw^d co, COL k f 0 c;r n d's 6a
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CONSTRUCTION,INFORMATION
t
Additional work to . e pertormed under this permit—check a tat appy:
_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: $ ..Or Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name ; ' /� Name: IJ
Address: 1�% t j L Company:
City: FA .0t-Qfee State:� Address:
Zip Code: Fax: City: State:
Phone No. 2,1 to 61357 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRCTIDN LIEN LAW INE4RMATION: `
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.
Signat a of Owner/Le ee/Agent Signature of Contractor/License Holder
STATE OF FLORDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The for g oing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this A4'day of 20-\-5p by this day of ,20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub c-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Iden ' ' Personally Known OR Produced Identification
Type of Identification pEANNA GIVE T e of Identification
tart'Public State of Florida Yp
Produced tr � (-� , . peo 16,tot roduced
Expir e EE 85878Ass .
Commission No. [��5` to . (�g�krlssion (Seal)
NationalN°tart ommission NO.
ed Through
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014