HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
CEq
MAY 12 2016
Building Permit Application Public Works
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 . ✓
Phone: (772)462-1553 Fax: (772)46271578 Commercial Residential
PERMIT APPLICATION FOR:
P'ROP®SED IN'PROUEME-NT LO:CATLON:
Address: 73 ® �azsi Zs
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Sei backs Front Back: _Right Side: Left Side:
DETAILED DE�S.CRIPTION O OR'K,
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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:
or
Cost of Construction: �1 5 Utilities: —Sewer _Septic Building Height:
OUV ER/LE�SSE'�: O TRACTOR•
Name W v' Name: f d^- :a:tz
Address: Company:
City:6,PC r-{o. a-e State: Address:
Zip,Code: 3y c, ' Fax: City: 4 State:
Phone No. '7 72-- 971 Z/8E Zip Code: F Fax:
E-Mail: to (P 401, Z a.,r4 Phone No v 01
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or ounty License
If value of construction is 2500 or more,a RECORDED Notice of Comm ncement is required.
ON TW C®N;SMR-MTC®N LIEN LAIN ItNF®R'I�IIATION:
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
comm ncing work or reco_x4ing youp,-Notice of Commencement.
-Si nat re of wner/Lessee/Contr ctor as Agent for Owner Signature of Contractor/License Holder
STA OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The YgRing instrLdrnent was acknowledgd before me The forgoing instrument was acknowledged before me
this ay of 20Tby this day of 20_ by
(Name of person ackn wledging) (Name of person acknowledging)
(Signature of Noty Public-State of lorida) (Signature of Notary Public-State of Florida )
Personally w OR Produced Identification—Z Personally Known OR Produced Identification
Type of Id ntiaraAlgn Type of Identification
Produced :��` `A.'•: LA 9 Produced
-State of Florida
commisslan#FF'Z
Commissi n' ��= My romm C� ( �� Commission No. (Seal)
•.,,oFrcB,.— -�^r (Pires May 27,2019
Bonded through National Notary Assn
-REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE" MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
I:Fev.