HomeMy WebLinkAboutBuilding Permit Application H
All APPLIC fBt,E INF MUST B COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: tXLA Z0 ,6 Permit Number:
E-05 �= ��-� ::{ RECEi :D JUL 012016
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: 1 b•1
PROPOSED I-(VP OVEMENT CATION a,
u
Address:_
Legal Description:
Property TaxID#: 1� a- � �� r �aR 1 "-�� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
S"�,.... _.vr.,.. ......F-<,: -...x� Air _ _x ✓. _c#s .d'*:. .Ys.a. .,.,.., a.a..
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CON5TRl1CTCON.INFORNfATCON x
Additionalworkto a er orme under this permit—check all that 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:$ JU , Utilities: —Sewer _Septic Building Height:
01NN f LE5SE CONTRACTOR
Name Name:
Ad s: E5 v� Company:
City: State:_ Address:
Zip Code: T2, Fax: City: State:
Phone N is O Zip Code: Fax:
E-Mail: U 1. OIYN Phone No
Fill in fee simple Title Holder next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU"PPLENIENTALCONSTRUCTIONFLI`EN LAW INFORMATION
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
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mencing work or rpcording your Notice of Commencement.
A)D�-A_NV4�;�
Signature of Owner/Lessee/Contractor as Agent for Own Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF S '� • L Uc�t COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I day of 7y 1 N ,20AG by this day of ,20_ by
CX Tlt
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu ic-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifition Type of Identification
Produced �t_ DL- Produced
Commission No. sq1�z I (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED F-7
ev.
WATER ,R'E CE{-�"t i :L Q 'i ST LUC UNTY U `IT I O.Mi 728 ,Fz:PIERCE FL 34982
SEWER RES
NAME IC
METER SZ: M/E
IRR ACCT.#
-
SECURITY DEP SE ;ICE ADI? S r vC
SERVICE;EEE ' L
SAME DAY:FEE
SUBDIVISION - L O}Tj r, , ,$LfOCK
OVERTIME-FEE
d METER INSTALL:,
BII,,, ADDRESS .. .
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CFC/VVAT ER
FPUA CFC PHONE# - -,----� dVE IN/CLOSING DATE
CEG/SEWER
GUAR:REV. This application hereby requesf Wand authorizes the Utility,to render water and/or ewage;disposal
seruices to-tne premises described•above in ac.,rdance,with the Utilities;present or fgture-rates,
LATERAL. rules and regulattons,whtchby reference are made apart of this contract:Applicant agreesto pay
t the Utility promptly for such services in accordance with the established rules''and regulations.
1 i.1 TaT L CUSTOMERS DEPOSITS ARE NON-NEGOTIABLE OR TRANSFERABLE
CUSTOMER
SOCIAL SEC/ `
SIGNATURE f �}
NAME OF SPOUSE J, SPOUSE SOCIAL SEC: '
'OFFICE USE ONL
DATE RECEIVED // �(r� CASH CHK RECEI. • BY ,r"`- '
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