HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INJO MUS B OMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: G
oS (o
;' _ _ . -
MAY - 4 2616
Building Permit Application P U b I i
Planning and Development Services St. Lucie co,_ _
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:
h PR®P®SED I1N'PR®x/FAVU N1' LO;CAI'LI fU°: _
Address: 3 L ;��e
Legal Description: ��4 r j 0,111A g M11
Property Tax ID#: �L'2S� ro6L 0 V 12 —L)OC-) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ESCR'I11PTION OF WORK:
DETAILED.D. 'f �^
Re � ?6,, Illec -c� Fire c w b gS
CONSTR�IJ.CTIC�N (!N3F®R�I1I)A�'I®N: .
Additional work to be pertormed under this 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:$ ��� Utilities: —Sewer —Septic Building Height:
®U1I11E� RESSEE7,21M 11: CONTRACTOR:
Name RoAe.,t Alf eiC ✓c/, Name:
Address:132 4f2r�r� lily Company: �/WI
City: fGr s9/A LuCt' Stater Address: r,"e
Zip Code: '3'5101 Fax: City: Stater
Phone No. pb6� �I�SS� j �� Zip Code: Fax:
E-Mail: Phone Nou67 760 233
7
_
Fill in fee simple Title Holder on next page(if different E-Mail �i�r 044/eh 2 Y7 ®6y»-e •ccvh
from the Owner listed above) State or County License /1,5'�S'_yS�_
73
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJPPLEMENI"P►L C.®NS �C1TI®N LIEN LAW INFORMATIQN:
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 our)property. A Notice of Commencement must be r ed and posted on the jobsite
before the first i s ction. If you intend to obtain financing, consult with le er or an attorney before
commencing rk ori"re ordin our Notice of Commenceme t.
Signature f Ow r/ essee/Contractor as Agent for Owner Signa ur of Co tractor/License Holder
STATE OF FLORIDA STA E OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,20_ by this day of . 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
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
Rev. 4