HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MLIT BE COMPLETED FOR APPLICATION TO BE ACCEPTED f ��(
Date: ��� Permit Number: & o 7-- 043
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Building Permit Application AFR 2 2 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 V
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PERMIT APPLICATION FOR:
PRC}POSED IM,"k-tMENT`I QCATI(7,N
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Address: 500S &M�bg
Legal Description:
Property Tax ID#: �J�Oa ^�0 C�g-C� ��1 ��� L4 Lot No.
Site Plan Namle: Block No.
Project Name: —!�G(,(/,�n ' _��/ft T� �•
Setbacks , F font Back: Right Side: Left Side:
DETAII:EDDE SCRIPTION OF WORK
P� c, 1 k X a
CONSTRUCTIC3N INEORi171ATlON
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Additionalwork to be pertormed under this permit–check all t at appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
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Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer —Septic Building Height:
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OWNERf LES5:EE CONTRACTOR `
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Name JQbName:
Address: Company:
City: Stater Address:
Zip Code: / r Fax: City: State:
Phone No. Zip Code: ax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or Cou License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU::PPLEMENTAL CbNSTRUCTIC}N LIEN-LAW INFORMATION
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.
Gtr O �
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA A� STA,TE OF COUNTY OF FLORIDA
COUNTY OF �S,}
The forgoing instrum nt was acknowledge efore me The forgoing instrument was acknowledged before me
this 2LD4ay of 20y this day of 20_ by
(Mame of person acknowledging) (Name of person acknowledging)
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(Signature of No Public-State of Florida ) / (Signature of Notary Public-State of Florida)
Personal Kr,�pwp, R roduced Identification ✓ Personally Known OR Produced Identification
Type of 1 vp GEC Type of Identification
Produc '• ' :°_ ota Produced
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Commi 9�iir��"' mm•Ex • tel) Commission No. (Seal)
l trough Nati n;MFV z "2019
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 4