HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: Permit Number: "0-3
RECEIVE
Building. Permit Application MAR 16 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:
Address: 3 tf'!,A/'S1.. l re! ;d,1C rl 3 9 Xd
Legal Description: rA?,Ae Law+ ti eivt
Property Tax ID#: 3 3 2�.. SD i�" a� q•D De��.z. Lot No. ,2 2
Site Plan Name: M k!Z�7,4 d Block No..
Project Name: _7'y /oy'"40 D
Setbacks Front_ Back: X Right Side: Y Left Side:
Wit"ionallForkMbeperfoormeMdunder tis permit-check all t atapp y:
Mechanical _Gas Tank _Gas Piping Y Shutters _Windows/Doors
Electric _Plumbing _Sprinklers --Generator _Roof
Total'Sq:`Ft of Construction: Sq. Ft.ofFloor:'
loor:
Cost of Construction:$ 7 .3ff-c1p Utilities: —Sewer _Septic' Building Height: 3
Name Jo/ N 1zm b/-igh O Name: c,22 -1o� ,�J
Address: 73 y 3 4u re r Company:
City: ���t 1�• LvGse State: F( Address: 4.2.3Z (,X e
Zip Code: O 161' Fax: A.,/!1 City: State:
Phone No. Zip Code: Fax:
E-Mail: �'9 Phone No. 771 - �11!5r/ _4P114
Fill in fee simple Title Holder on next page(if different E-Mail: S,'(,44 1'C
from the Owner listed above) State or County License:SS CC 13
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Nopplicable MORTGAGE COMPANY:. _Not Applicable
Name: m Name:
Address: A / Address:
City: State: City: State
Zip: Phone: Zip•, Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: JA 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.
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 theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or dnd-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 fullconcurrency 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
commencin work or recording.your Notice of Commencement.
Signature of Owner/Age /Lessee, Signature of Contractor/License Holder
STATE OF FLORID_ - STATE OF FLORIDA
COUNTY OF COUNTY OFJr
R.
The
The forgoing ins. ment was .cknowledged be PO The forgoing instrument was acknowledged before
this day of 20 b this 1-day of? i�i ,20 by
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Pus
(Name of person acknowledging) z �.o (Name of person acknowledging) o=
m ru 8z�
colru
25'ST
C20�0
(-Signature-0
tary Public-State of, lorida)Lit
(Signature of No a- Public-State of Flori a)
/ 'Personally Known/ OR Produced Adenn . Personally Known � OR Produced Identification .
Type of Identification Produced Type of Identification 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
Rev.7/2014