HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: . Permit Number: 1&0 ' ��
i, �..��-
BUilding Permit Application
RECEIVE
Planning and Development Services
Building and Code Regulation Division MAR 2 9 2016
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
-OSS i ; kc fce- I
c .,• �� � - m h:a aK °tc�.5a • 'st�'a•'. NR
x k��s � *`,.�"a. •ax, 3'
����: �� � ��
-� t._.. �+ ,�s_�m:r$'.��� ��-.wrt�� .�,a.•. ,b_...�;M� w_.��.�<-_-,.�.s��5..���.z..-_ % ��. e� ..R :�.. :��.�a�'sr�4b ��'
Address: v PC �J
Legal Description `L LGk,1 Tx: ;e,5-
Property Tax ID#: Lot No.
Site Plan Name: Block No.'-
Project Name:
Setbacks Front Back: Right Side: Left Side:
kui
(&-e e me o-- ac, n
y, � '"i i3 � ,s `0480
"�a 'u z{ a ` ,+•�'i4 f I; `"4
C(?NSTRUCTI {�' NFOR ATION� E2n' ��
ce,.. ;e,ef. .'`j ...a : ` _i`rc
Additional work to a pe orme un ert is permit—check all.thatapp y:
echanical. _Gas Tank _Gas Piping, _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction:. Sq. Ft.of First Floor:
CJ
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
.,.q: �w� �„ �r t�s��zy y'�°� ," �+�,.'^aa�'..� � ' x�`'`�a"tw `� �t ,�'*�%�y�,,w•s,A �� � •:>�*, ��•s aµ �x,;•R 3.. 43 a,�x3�k :'"�� i.�''�� w' �.x °. �. z�vi`�a. �;
OIt�NERL � r�� � �CC)ItACTOR pp ,�
�..<.,-...i N�.
Name i Name:
Address: PL Company: L
City: 91 0'�-A State:G Address: lb C(PtG IRS
Zip Code: D�,k% ? Fax: City: State:I(AS
Phone No. Zip Code:q f c - Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail to 0�1 l oF'�2�L� SSG j v�-
from the Owner listed above) State or County License CAC l c91 WP)9.
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
z. ''a- t.x, - '.,_;:... �'a x✓,,� t. ,fi -•,r'„ I; 's ,: s x ti r t , x � x. :: .4-w.L sa + "a i
SEI�PPLE°°MEN`T�►L.COIVSTRUCT#Q�I'�LIE�N31A�N���FORM�AT(ON �ry�� *� �, �- � �,`��� . k�
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
IVame: ,_ ivanie:
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.l 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 th ! st inspection. If you intend to obtain financing, consult with lendr`or an attorney before
commenciyfg work or recording our Notice of Commencement.
S' nature of caner/Lessee/Contractor as Agent fo ;.! :OPw., Signature ofrLOrR'IDA
actor/License Holder
/STATE OF FLORIDA 2 l '? A+? ' STATE , rt
COUNTY OF �1 '46C1� C COON OF -
z xc,a
The fo going instrument was acknowledged before m 20 5 The f Ing instrument was acknowledged ego
this day of /��L/ ,20� by o g,N�. this Nday of 26A
fox �Zc
v
(Name of person acknowledging) iVa
ame of person acknowledging)lix
(Signature of No ry Public-State of Florida (Signature of Not Public-State of Florida)
Personally Know1� OR Produced Identification// Personally Known OR Produced Identification
Type of Identificatio Type of Identific io ,
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.