HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: `cz0!S`d
=� = RECEIVED MAY 2 7 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 .%
PERMIT APPLICATION FOR: �c _ v•4
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Address: �.
Legal Description:TbIA y, iq -3i 1
Property Tax ID#: A 310 "�O — ()L c'`f'1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Add itiona work to be pertormed under this permit-c eck 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: C3D Utilities: —Sewer _Septi.c Building Height:
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Name �L Na'me:''`
Addressompany
`City: , , .�.p 'C'A State: Address.
Zip Code: 2�LRL(5_ Fax: City: State: �PL
Phone No. -_+�2.. - to ,5319 0 Zip Code: S-3k- L-e Fax:
E-Mail: Phone No C'l S-4—gnn
Fill in fee simple Title Holder on next page(if different E-Mail Q&� Ile no-Se�ci0CQ-1NQL.o"fid R_Ca'
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. '9A 5
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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 he I t inspection. If you intend to obtain financing, consult with lender or an attorney before
comme cin work or recording our Notice of Com encement.
Signture of wner/Lessee/Contractor as Agent for Own nature actor/
of ContrLicense Holder ,
STATE OF FL9IF�► STATE OF FL A
COUNTY OF1`\(�f\ ��, COUNTY OF ��� r�a��,�,�.
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this�day of M_QS, 1�'20W by this day of 201(0 by
IAC`s.�
(Name of person acknowledging) (Name of person acknowledging
(Signature of-Notary Public-State of Morida) (Signature of Notary Public-State oVFlorida)
Personally Known v--__OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification -
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Produced .�' Heather Spew.,
Produced
COMMISSION dFf242 ���kP• - Heath4Spes
) EXPIRES:June 21,2 1ommission No. � SI COMMI2.1Commission No. al )iF' �� WWW.AARONNOTARY, OM ` EXPIRE2REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGR
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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COMPLETED
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