HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: RECEIVED.' Permit Number: t
MAR -0 9 2016
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W. iCOU`Aermit A lication
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Planning and Deve/opmentServices \
Building and Code Regulation Division �C
2300 Virginia Avenue,fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address: ��7 IV,!L77 — ['y�
Legal Description:.
Property Tax ID#: ® Lot No.
Site Plan Name: Block No.;
Project Name: �./�/�/� /SDS 7—
Setbacks Front Back:
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Additionalworkto a performed under this per mit all that apply:
_Mechanical _Gas Tank Gas PipingShutters _.Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �� T Utilities: _Sewer _Septic Building Height:
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Name /f(,9e4Z g,1 Name: 17
Address: Y,97 A.W7z ij Al— yb Company: V
City: �,v.e Stater/ Address:
Zip Code: Fax: City: State:
Phone No. 7Y —4:,� Z 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 Coun icense
If value of construction is 2500 or more,a RECORDED Notice of Commence--int is required.
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DESIGNER/ENGINEER: _Not Applicable _ MORTGAGE COMPANY: a _Not Applicable
.-Name... - -- --. _.��.._ d-n_fe 7—
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.
Icertify 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..Lude County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screenrooms-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.
/gri(dtt'urre4'of Owner/Lessee/Contractor as Agent for Owner Sign nature of Contractor/License Holder.
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_ 37c COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowled d before me
this.Z day of A2lf,4C2 ,'20&by this day of _ by
(Name of person acknowledging) (Name of person acknowledgin )
(Signature of NotP6 Public-State of Florida) (Signature of Notary Pub c-State of Florida)
Persona O Produced Identification Personally Known OR Produced Identification
Produc ?�Type 0!, n otar M HUFF Produced Type of entificatio
e otflorld�.
CommliStan_ W2 �j p
Con iacclr„,,o MY Comm.:Exblres May 21� i � Commission No _ (Seal)
on ed tllroopry National Not
�y Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW. REVIEW REVIE REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014