HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 <6, Permit Number:
RMC ('Y Li PYLA t 0 8 6016
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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: G�`,`
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PRgOF�#JSED INPROl/EMENTLC}CATIO : roE � r I 1.
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Address:- � � Co�v J�/�w, "�" i�u�i.�,, �r��; f_� 34-I911J
Legal Description:
PropertyTax ID#: 9V36- 601 00,11 660 - S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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ILEES`CRIPTfON OF'WORK rx; irE#M ;,;
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CONSTRUCTIGMINFORMATION ��Fl, iiia
itiona workto, e pertormed un ert is permit-cneck all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construct'o Sq. Ft. of First Floor:
-.Cost o.f.Construction: $ a a�, oo Utilities: _Sewer _Septic Building Height:
OWNERLESSEE� °” -CONTRACTOR: by
Name 54POhen Lpwi(�e, Name: &I,c L-e.. ur*e a
Address: 305 (aco V(A CCompany: rl�l1..� p►C
City: yakffi C ` State:V-_ - Address: 3, 101,41-Le-S-bv-Z-
Zip Code: Fax: City: F State: FL_
Phone No. Zip Code: 3Y 1 Y 7 Fax: -OYYO
E-Mail: Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail: f,y IrP ✓ll'�L� ��, CCS
from the Owner listed above) State or County License: S—S—J 7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Wirenutsino 7724660590 PA
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 thepermit 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-
inconsideration 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 your Notice of Commencement.
4 - -
Signature of Owner/Agent/Les§ee Signature of Contractor/Likensif Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 54- bkue, COUNTY OF e—
The for
0 cling instrument was acknowledged befo e The for ling instrument was acknowledged before me z M
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(Name of person acknowledging) I (Name of person acknowl4dging) V X
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(Signature of Nory Public-State of Florida) (Signature of Nota Public-State of Florida
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Personally Known Ve OR Produced[dent! ry + Personally Known OR Produced Identification
Type of Identification Produced Type of identification Produced
Commission No. Tp oq_fpq 03 (Seal) Commission No. FF016il (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
-COMPLETED
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