HomeMy WebLinkAboutBuilding Permit Application C_� k I --rC_l(r\0 t U (.e.J
All APPLICABLE IN O MUST E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: lsp J
RECEIVED '
Building Permit Application MAR 15 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:
-?ROPOSED1 INPROVEMENT LOCATION..,
Address: 7'S 5 1 W h ift .l b i S Loom lot(+ -4,4— Lock FL q 915
Legal Description: le+-reoA A-T- Sad )O IVIa�'� L!h
PropertyTax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:_
DETAILED DESCRIPTION OF=WORK nz;
L C --e ad( Do r n ejuj `t C C�
c-n. f rV6 P a� r n4 ao ic:�.7'y re C7 e- g�r/1r5.
CONSTRUCTION,INFORMATION.
Additional work to be pertormed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers Generator _Roof
Total,Sq. Ft of Construction: 01 3 s Sq.Ft. of First Floor:
Cost of.Construction:$ J 4S 00 Utilities.`::`. =Sewer _Septic Building Height:
OWNER/LESSEE ;CONTRACTOR:, ., .' :..
Namey ����'' I U C,E �~ Name: > >cw.1 e k 2A'y ,
Address: '2 ,9 ,5 (i A tie- Ai- �,n Company: ►4I( g_m e.i'tr�_I UiI C(ei s% hpi cA t era
City: t1-rte,- S 1 f ��c�ic StateL Address: 2 OD t 5 62yiC5l� �lv�
Zip'.Code: Fax: City: POnr - 5f. L L)6,e State: f-L
:Phone No. q _!S Sr) Zip Code: `19 S2 Fax:
&Mail: Phone No 3 S Di " 7S-L(-2
Fill in fee simple Title Holder on next page(if different E-Mail dew -,,I
from the Owner listed above) State or County License Cl/LC Darn �'lo
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTRUCTION LIEN LAW INFORMATIQN
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 your
Notice of Commencement. /
12
Signature of Owner/ see/Contractor as Agent for Owner Signature of Contra c /License Holder
STATE OF FLORIDA STATE OF FLOR
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before m �ti;;;z••. The foing instrument was acknowledged before
this�day of�&Zb 20� by ,i thisday ofnl f 20�� by ;,a.•,
WD"1 +0 �
0
(Name of person acknowledging) 7o8 o (Name of person acknowledging)
(Signature of tary Public-State o lorida ) a N�9m (Signature of N t y Pub ic-State of orida) .
a OA G C QTS
Personally Known OR Produced Identificatio �N Personally Known OR Produced Identifi 44.4,_T
Type of Identification Type of Identification as ^'
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014