HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETEDTOR APPLICATION TO BE ACCEPTED
Date` Permit Number:
I
r„,�^-c:
Building Permit Application MAY "1 1 2016
Planning and Development Services
Building and Code Regulation Division
2300 Virginia�4venue,Fort Pierce FL 34982
Phone: (772)I 462-1553 Fax: (772)462-1578 Commercial Residential I/
PERMIT APPLICATION FOR:
PROPOSED INPR®1/EMNT LOCATION:
Address:
Legal Description: L!� l� Z� �9'191y�lG�J`� I � / �d
Property Tax �D#: f : 2 f V Co 0-V 0_l Lot No.
Site Plan Name: Block No.
Project Name!: '679k c—Ly&-o E)
Setbacks Fi ont Back: Right Side: Left Side:
Slang 111 =0 I rN
DET�AI�!_ED DE�S��R�I`PTfiON OF V1lORdK: Pr WIWI
12
®NNTR ffl"o— ON I fN1FORM ►Tfi�N:
Additional work to be pertormed under this permit–check-a-ll that appy:
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electril _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: aDO Sq. Ft.of First Floor:
Cost of Construction: $ 4009, z;op, D0 Utilities: —Sewer _Septic Building Height:
Q�WNER/LE�S�SEE• Cf]NTRACT®d.R;
Name Name:
Address: _ Company:
City: State:° -s Address:
Zip Code: c� Fax: City: State:
Phone No.� Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different E-Mai
from the Owner listed above) Sta a or County License
If value of coInstruction is 2500 or more,a RECORDED Notice of Commencement is required.
S�IJ�PPLEIUIE�I�I"A�C®NSTR�UI®.N LIEN 11N I(y�`CI,R+It��T 0'N:
DESIGNER/ENGINEER: Applicable MORTGAGE COMPANY: _ Not Applicable
Name: C m Name:
Address: 02 Co 011 i71/G- 1/E 1 TVdreis:
a}City: State: City: State:
itZip: 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.
MZ8.8
Signatureof wne [Lessee/Con or as Agent foSignature of Contractor/License Holder
STATE OF FLORIDA - STATE OF FLORIDA
COUNTYOF COUNTY OF
The forgoing instrument was acknowledg before The forgoing instrument was acknowledged before me
this�dayof 20Y(0 by this day of 20_ by
A�I�
(Name of pefson acknowledging) 11 a (Name of person acknowledging)
/2vy J9'/'M- '�v it4—�a6aa--�' -
(Signature of Nota ublic-State of Florida) (Signature of Notary Public-State of Florida)
Personally , wn OR Produced Identification Personally Known OR Produced Identification
Type of Identif' on Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 4