HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l� • �,. . ) �. Permit Number:
RECEIVE®
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- Building Permit Application JUIN A 2016
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:
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A�ress t� e�tr v a� lv/ 2 _� 1
Legal Description: !'!
Proper�.y Tax ID#: {1 J b t 1 0-3 ""(�00 '-1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
C1AIL ® DCRIPTIOFN OF 1NdRK.,
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hsl e I f 3�r •e. shed b a 10 r-0
CaNSTR�,UCT# A - "`3flx �'�� �rc .f ': 1 �r�*j'�„�3 •de ,x��m,"�3�s
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Additional work to be pertormed under this permit-check all that apply:
—Mechanical —Gas Tank —Gas Piping 'Shutters Windows/Doors.:.
—Electric _Plumbing —Sprinklers _Generator _Roof
�Fota1 Sq-Ft of'Construction-- O /6 )�) Sq. Ft. of,First Floor.. !
Cost a£.Construction:$ 3 'JJ yrJI�V Utilities: —Sewer _Septic Building Height:
-�yr:,x-, ��
ONER/LEkSSEE �� ,{ aax� F= drt d,f ONTRA , 03 t� ,n �;� °
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�Na.me� c1[bY1 C' Q Name:
tl M�S A.s`6�;A.��P
Address: � � �L.( v Company: � .
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City:';Fcr�- PL 2 re I✓ State: Address: ,�F;� $ T,®
Zip Code: 3cfq 51 Fax: City: State:
Phone No. -�5 5ol- oS �_3 17#2 Zip Code:20;7�,-70 I Fax: JW.4,
k E-Mail: Phone No ;7!7(;;Z C�
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Fill in fee simple Title Holder on 9ext page (if different E-Mail
-my—m-t e O ner listed above) State or County Lice nse'j79-C,
i°
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ,
llRI00, ENTAWC 1 111 MR NRMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name Name:
Addresses Address:
City State: City: State:
Zip:# Phone W 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.
rSi trrre-af)wn—& e / ntractor as Agent for Ow Signature of Contractor/License Holder
;�b�."•
ATE OF FLORIDA P b: �= STATE OF.,FLORIDA
OUNTY OF = COUNTY OF
*„
The for oing instrWVnt was acknowledged befne�__ The forgoing instrument was acknowledged before me
this day of 20 by this day of ,20_ by
Sa NSa 93
�.�o x
Or lie �Z=
(Name of person acknowledging) �T 9 (Name of person acknowledging)
�N
(Signature of No r Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification / Personally Known OR Produced Identification
Type of IdentifiType of Identification
Produced `C' . 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.7/2014