HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE FO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f /61 Permit Number:
RECEIV':D SDN 13 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 —7)��
PERMIT APPLICATION FOR: �C
PROPOSED INPR®�/E�MYENl' LOCATLO'N:
Address: 5-910 \3 CA �e-&4e J'C)U C Vr0:5 FL 3,cr 7?"D_
Legal Description:
Property Tax ID#: 3�(�a^ (.vi r c3 Sia — Coo Lot No. 7
Site Plan Name: Block No. �
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESS 'RSI TIO 0`F WQRK:
rlLe ��lac — �• s I�i I_ S P� F 4-
CONSTRUCTIONI` FORiMAT)fflN:
Additional wor to be pertormed under this permit—c ec a tat 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:$ SUy Utilities: _Sewer _Septic Building Height:
OWNER/ 9SINSEE: CONTR GTOR:
Name C,^e_ U. Name: 0t,t(e C,42C
Address: e✓a rX Company:
City: t C/CC State Add res S�/ �Or/ie�.c'l Gz fst
Zip Code: 3L(l F 6*�- Fax: City: 0,4 State: FL_
Phone No. 772 - 77 Y/27 7 Zip Code: Fax:
E-Mail: Phone No 77,2-
Fill in fee simple Title Holder on next page(if different E-Mail 6 L'G �c cry
from the Owner listed above) State or County License cfWAC
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR CTION LIEN LAW 1 1%.ATION:
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.
L,
ure of Owner/Lessee/Cont ctor as Agent for Owner Si ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 1-\-)'- COUNTYOF
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this 3 day of�`� v1 Q , 20\� by this day of ,20 by
(Name of person acknowledging) (Name of person acknowledging)
.i
(Signature of Notary Publi State of Florida) (Signature of Notary P lic-State of Florida)
Personally Known OR Produced IdentifLpDie ersonally Known OR Produced Ide tiS i c�tio
Type of Identification s pEN1 Gi I Florid'fi ype of Identific;ion p -1. pEANNA state of Florida
Produced t- �1—�' ;�� r public Slate c 16 20 oduced fir`
Y ices De blic 2018
ref,
r My Gomm'Exp #EE 858761 ?�« °a` -E Comm.Expires Dec 18
Commission No. [.C�e ° �" = (5�,aljrmisswl p s s — 3 MY commi EE 858761
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014