HomeMy WebLinkAboutBuilding Permit Application i
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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i Date` 1 _ ( � Permit Number:
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{. • RECEi`. .D MAY 18 2016
_._____ Building Permit Application
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
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PERMIT APPLICATION FOR:
PROP®SED INP,ROVENIENT�LOCATION;� , . :`3 .. x. r 4 : � y n m.Ft.
Address:
Legal Description: ?A-P1 C-)
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Property Tax ID#:�A 1b S�� >7��b ' 000 Lot No.
Site Plan Name: t lti' Block No. 0
Project Name: 44��a.4 t,-ke 1-] lj�s..r,a
I Setbacks Front Back: Right Side: Left Side:
J'PE' T'A'IL"6DES.CA1 RK• '`
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CONSTRug fON},INFORMATiDN ,F r
Additional work to be pertormed under this permit-check all that appy:
ZMechanical _Gas Tank _Gas Piping _Shutters -Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
j Total Sq. Ft of Construction: �5� Sq. Ft.of First Floor:
ry
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
OVtlNER/LESSEE CONTRACTt7R�
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Name Nam.
Address: ,q-,0 Company:A4--C-riz-- 1-2 CGja��
City: F-bt',-vika- —a-e is State?t-- Address: 5'1 1 M�1�c� i`�l L 16 1�-
Zip Code: 1 Fax: City: Q,,-V Ste' State
PhoneNo.'t'12, Zip Code:SIAS Fax:
E-Mail: Phone No. '1-12- E5E k
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:C�-« (L06:5 9
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. J1
SUPPLiEt�T'AE CCINSTRUCTu � I�.l�N,.�.A � , � � ,
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 recordin o r Notice of Commencement.
Signature drowner/Agent/Lessee Signature of Cop-or/License Holder Z _
STATE OF FLORIDA Ie STATE OF FLORIDA
COUNTY OF COUNTY OF L e o
o � ca
The forgoing instrument was acknowledged W The forgoing instrument was acknowledged befor, rhea
this day of d 2d ?� . this day ofb , z4� by z o
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C..ice 1�C �\'� F'_�,'���m� {, •' -' t�J1.�
(Name of person acknowledgin ) ,.� ,m' (Name of person acknowledging
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{Signature of Notary Public-State of Florida} (Signa ure of Notary Public-State of Flori a
Personally Known_�OR Produced Identification Personally Known V" OR Produced identification
Type of Identification Produced Type of Identification Produced
Commission Nor -019c (Seal) Commission (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
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COMPLETED
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