HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Date: 'C• Permit Number: ( CD;RECEIVED
I
Building Permit Application JUN /9 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 n
PERMIT APPLICATION FOR:
PRO1010070
Address: S ?�� C�SSoLiGt S r - �l 2,rC1L 3 _fqs )
Legal Description: )'0 3 9 39 /� ��Z S 1/z d F -S� i�q0 F >VG7 //L/-LFsS
RNA c_c—ss w coo FT- ( 5- '99 hC) EX- 4112_ -(1 '7Q
Property Tax ID#: 3 ) 1 -3-3 0 0 0 ) _ 0C) ) Lot No.
Site Plan Name: MOY r ► S Block No.
Project Name: Ko r►S
Setbacks Front Back: Right Side: Left Side:
DETAILED
E. I OF WAiff
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CONSTRUCTION INFO'RMAT'ION:
Additional work to be performed under this permit-c ec ;a .t at appy:
Mechanical _Gas Tank _Gas Piping:' !Shutters _Windows/Doors
:Electric. _Plumbing _Sprinklers Generator _Roof
Total SgJt,of°i onstruction: °Sq. Ft.of First Floor:
Cost of to' fiction:$ �, Gl S Z Utilities .,u Sewer _Septic Building Height:
01NNER�LE�S�SEE: t CO.NTRA�TOR:
Name C G►'�0.a—d l�- o r�i Name:- --�i rc 0,
Address: S_7 S ec.X SG,.r- S VJ • Company: V, \v.y-r► e0,V
City: State: Address: \010 t,,�
Zip Code: IS ( Fax: City:��c ����rcSL State:3H
Phone No. `1-1Z 332-—(,:S -7) Zip Code: �jy�S Fax: lc1 Ll- VS 611
E-Mail: Phone No -7-7-Z-
Fill
ZFill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License X431 4
If value of constiuction is 2500 or more,a RECORDED Notice of Commencement is required.
SLII'PEMENTAL CON'S"TRUCTI�N LI'�EN LAIN IN'F®RMAl'1®N:
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.
Signature I
f Owner/Lessee/Agent Signature of Contractor/Li nse Holder
STATE OF FLORIDA C4 - STATE OF FLORIDAJy
-
COUNTY OF (-7 1 COUNTY OF '
The f going ins ent was acknowledged before e. ;The fo oing inst m nt was acknowledge before me
this day of 20� by °i: ;this day of 20� by
G'� i ��se� �_�� P4
(Name of person acknowledging) (Name of person acknowledging) Z
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(Signature o otary Public-State of Florida ) �J$I (Signature of otary Public-State of Florida ) �w
Personally Known L/ OR Produced Identificatio %;;r;fit' Personally Known i�OR Produced Identifi tj'n
Type of Identification Type of Identification _ o=
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 112014