HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO fMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Z6,�,Q
RECEIVE®
R_ Building Permit Application MAR 23 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: /�en Ce
PROPOSED INPROVEMEN,T I,OCATIOt .ik
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Address: ��'1/ /��le0 n 40e_ Afw^ee. [- 3g95 l
Legal Description:
Property Tax ID#: !30 r I LI -a 13 0 —ODO—2 Lot No. f 2
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIC~N OF WORK
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CQ3NTRUCTION INFOR1111A710N .. s ..
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Additionalworktov a pe orme un er t is permit—check all that 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:$ 2 qUtilities: _Sewer -Septic Building Height:
OWNER% ESSEE` a . . ONTRACTOR
Name i e / l S i2✓S Name: 1 )ennie, C.W
Address: SS1 1 LeoCompany:. ) I�f,�3 ,Ci�!)S�'tit
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City: P State:iC� Address: /� q qaA .S
Zip Code: 3L/°J�/ Fax: City: CL m Ci State:
Phone No. 3-70- 2-Y4 a Zip Code: Sy(?g0 v Fax:
E-Mail: Phone No. rl'-72 Zo v LA H L4
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: CGC 0 ISr13G
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INI✓ORMATION
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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.
Signbture of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF j� l �j COUNTY OF
The for oing instrum nt was acknowledged before me The forgoing instrument was ackn wledged before me
this Wday of 20 1C 6y this_&day of .2(�/&by
L '� '�'7 " -�- Jyuu) A-2/411�'� VLA
(Name of person acknowledging) (Name of person acknowledging)
)a zla� i ul&-- i"
(Signature of No y Publi -State of Florida ) (Signature o Notair ublic-State of Florida)
Personally Known OR Produced Intification Personally Known OR Produced Iden fication
Type of Identification Produced A a_0Bg�� 9 . Type of Identification Produce
atp�p X.
WENDY K.WELLS t'�� NOTARY PUBLI
ONE
Commission N ' S NOTARY Commiss
; ion No. '� I)
ATE OF FLI;RIDA cgSIAIEOFFLQ
j Comm#FF007970Comm#FF007970
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Expires 4/14/2017 1 F Ar es 4/14/2017
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW_
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014