HomeMy WebLinkAboutBuilding Permit Application i
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All APPLICABLL/E, INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: °`1-" o`� / Permit Number: ��CP V 7"/
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SECEIVED
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Building Permit Application APR 2016
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)i462-1553 Fax: (772)462-1578 Commercial Residential 0
PERMIT APPLICATION FOR:
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501
PRQPOSED INRRfJVEl1/IEN�T L® TION: s. s,
Address: '$
Legal DescriptIIion: L wtr Esk4e,5-unit-09MIS 51 lo{ C1 riiiP 314A10,1�LK Aq9 30
Property Tax IID O 3L5a-(0(N-�1g5-Ql0-5- Lot No.
Site Plan Name: Block No.
Project Namel ® 131, 991" t,75
Setbacks Front Back: Right Side: Left Side:
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DE`fAILED DESCRIjPTION OF 1111®,RFK: "i
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iL( aa-A-e, 00A sdP
CONST°RIJCTIQN INF®RrMATfON: " ,
Additional wo rto a pe orme a under this permit-c ec tat appy:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing
l �+ _Sprinklers Generator _Roof
Total Sq. Ft of Construction: $ 20;a Sq. Ft.'of First Floor:
Cost of Construction: $ \500,00 Utilities: _Sewer Septic Building Height:
OWN:ER/LESSEE: CONTRAC1"OR;
Name llivirg - 9c 4k, Name:
Address W1c (0C 9- 9,,-r 1)"', Company:
Citylp '-t & State.-"r( Address:
Zip Code: *L(W- Fax: Of City: State:
Phone No.0 'l�'� -I -o(d l Zip Code: Fax:
E-Mail: 0 ViC6,ri&lunv\10�!j4Jwo,.tovk Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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Evalu
e of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJFPLE11lIEN><�L C,ONSTRIJ��TION ltE'N 1�1W IN'f:OR=NAT'IO`N:
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.
Signz.ao O,wr�rei</ 'essee/C ntract as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID - STATE OF FLORIDA
COUNTY OF COUNTY OF
s.�••"•Mor:
The fQrgging instru mpnt was acknowledged e The forgoing instrument was acknowledged before me
this "r/ day of nhit 20 f ;; ,. this day of 20_ by
y 0/0a
a�
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(Name of person acknowledging) cgm (Name of person acknowledging)
se
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(Signature of otary Public-State of FI Ada) �N (Signature of Notary Public-State of Florida)
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Person o
wn OR Produced Identi Produced IdentiPersonally Known OR Produced Identification
Type ol ation Type of Identification
Produced Produced
Commission (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.7/2014