HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:TPermit Number:
R E C E 11' D JIM 2 2016
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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
POSED T-1 - A
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Address: O ,l'
Legal Description:.. �16n
Property Tax ID#: 6--8CC Lot No.�� �
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAfIED DESCf�IP�"ION�k OF ,I-, - K r �k
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,CONSTRUCTlO�t�INEOf�N(ATION
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Additional work to be performed uncle r this permit-check all tat appy:
_Mechanical _Gas Tank —Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator V_Roof
Total Sq. Ft of Construction: ( j_� Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height: l0
0 -00T
F CONTRACTOR: r,
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Name C l Name:
Address:at t VeAA'" Company: ' Cb
City:k®b Re,sC� State:M Address: �0
Zip Code: Fax: City: G State:
Phone No. -70 67L7� Zip Code:3 Fax:772-3�S-o
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) 6t�eor County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPP�EiUIENAL' Oi�STRU�TlQNLtENLAlIfi11�VafMATlSQN:�;
DESIGNER/ENGINEER: V Not Applicable MORTGAGE COMPANY: VNot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: 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 of Owner/Lessee/Agent Signatur of Contractor/License Holder
STATE OF FLORIDA L 1 STATE OF FLORIDA
COUNTY OF "e, COUNTY OF LU Cie,
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this o1day of , 3 I) ,20�,G by this aday of 7S y20�G by
(Name of pe son acknowledging) (Name of person acknowledging)
(Signature of Notary Publi State of Florida) (Signature of Notary Publi -State of Florida)
Personally Known OR Produced Identificatid-h 9 Personally Known OR Produced I tification
Type of Identification N � es \uC2� ProducedType of entificatio s� ,.�`,`�P�wE�U,F�o�\aa ',
Produced L i_ FN Spat °1�a, �6 \ r CIE _Slade 16
Commission No. 0b�tc . �sde� tal6� n.'A Commission NoM ,
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;�NIN�G SUPERVISOR PLANS VEGET TI TU REVIEWS FRRTLE MANGROVE
ONar.;;;_E
COLINY RE„REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. //2014