HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST 1BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: • /. / Permit Number: Aa
RECEIVED
M Tm Building Permit Application MAR 31 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:
PROPOSED INPROVEMENT10 ATION
�.• ..,. . ,k pp �.
Address: lam(. ✓ ��
Legal Description:
Property Tax ID#: s3/ 3 d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front jd Back: Right Side: Left Side:
DETAILED DESCRIPTION�OF WORK
I�Gw Pmt �21C 6 S
CON STRUCTIINFORMATIO
ONN
Additional work to be performed under t is permit-check all that appy:
f
_Mechanical —'Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction:- 1.3 21 �e, Sq.,Ft. of First Floor:
T �
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
INNER/LESSEE ` 6 ,,...:CONTRACT OR
ame elJ f �. �. F}.�,r,.sNWI ... . . � G. L.
Address:.,.; Ci l ip"af""
City:_ ✓` )�/C
a It State c_K--1 n lddress,: �
Zip,Code: Fax: `" ` "`Chir _" State: l
Phone No'. �� Zip Code: ;� / Fax:
E-IVlaii•:�:(1= �`LLo .�_ iXC 2IL��+� Phone No �-� / S'�
., ----r
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License 6;x
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSl'_RUCTION CION LAW INFORI /IATION<
/ _ a-. -- Applicable MORTGAGE COMPANYNot Applicable
DESIGNER/ENGINEER: Not A licable : oca
e
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,,
c
mmencing work or recording our Notice of Commencement.
Q.
Signatur Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDAj� .
COUNTY OF J✓Ut5e COUNTY OF
Theforgoing instrume t was cknowledged before me The forgoing instrument was acknowledged before me.
this a day of P 20� by this day of 20_ by
(Na�pf'plrson ackno I in (Name.of persona owled ' '
(Signature of Notary Public-State of Florida} Si n e - Puublic-� # ida}
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of identification
Produced �rumy
_ GUM i. MASON
Commission No. Malery PuWia� uttelnfttWPo No.77
(Seal)
MY Comm.Expip a Cep 2.2017
r Commiselon A FF 050159
I sib
^" 4
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATI0 ;, $ : f�Yr� V
COUNTER REVIEW REVIEW REVIEW REVIEW".".. ®b ►arlE
DATE
RECEIVED
DATE
COMPLETED
ev.