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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ///�� /I Date: • �Le • Permit Number: / (Q 0 l • 00 I RECEIVE® • _ JUN ® 1 2016 aW, 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 I PERMIT APPLICATION FOR: 11 PROP®SED I'NPR®uEn/IENT LOCATON R ryffiV TM , i _gym Address: /3I© � �Ca-y j m©O 7.e-- P t06�-Qy CA,4NC (GL 3 tf D Legal Description: Property Tax IID#: 44 2 3-660 Z_ Lot No. Site Plan Name: Block No. Project Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION QF WQR=f I C®'NSTR�I)CTI®N t{N�F®'R�MATI®N: u Additional w rk to be performed under this permit-check all that apply: _Mechanical _Gas Tank ' _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing. _Sprinklers _Generator _Roof Total Sq. Ft of ConstructionSq. Ft. of First'Floor: Cost of Construction:$ O s Utilities: —Sewer _Septic Building Height: O�WN!ER/LESSEE: C® 1°RACi®'R: 211 Name �1,Ckr-tQ—jQ- / E)o✓ Name: Address: r7(n eo-vle-�L�<�� -7q�:' Company: C-CI► " C'iOv" 2 ctz�ft el City:" C L-� • State:— Address: Znl r- Zip Code: 3 U'9 Qt 6 Fax: City: (n• �>• L State: Phone No. 3 3 (n 5 6 Zip Code: 34(4 52— Fax: E-Mail: Phone No `7 7 2 3"7�`7 `7 7 3 3 I Fittin fee simple Title Holder on next page(if different E-Mail —qa-r,bL 61-iA r (U ° from the O �the listed above) State or County License g \� �\ If value';'co i struction is 2500 or more,a RECORDED Notice of Commencement is required. I SU�PPLEf1lhENT'AL CONSTRtlC�TI�N-L'IiEN I_/\W INF®Rall/,l�l"ION• 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 recording our Notice of Commencement. -10, _ 0_ Signatu a of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder —� STATE OF FLORIDAJ STATE OF FLORIDA COUNTY OFCOUNTY OF • - ' >� The forgoing ins6kent was ael nowledged before me The forgoing ins ent was acknowledged before me this day of 20Z(Q by this day of 20Z by O hn '9 h n .1�L;f'�I I �Y� (Name of person acknowledging (Name of person acknowledging) Signature f otary Pub ic-State of orida) (Signature of No Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification✓ Typeof Identific io Type of Id i tion d'c'-Sc'Produced Produced - Commission No. (Seal) Commission o. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE - COMPLETED ev. 4