HomeMy WebLinkAboutBuilding Permit Application A11 APPLICABLE INFO MUST BE CQMPLIM0 FOR APPLICATION TO BE ACCEPTED
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r, Building Permit Application JUL 1 1 2016
Planning and Development Services
Building and Cbde Regulation Division
2300 Virgin1d Avenue,Port Pierre fl 34982
Phone,,(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: 4wwavnt
W.
Address:
Legal Description: �°
Property Tax ID#: fico - S=0 X15 - Lot No.�[.4
Site Plan Name: Block No. l"
Project Name:
Setbacks Front Back: Right Side: Left Side:
ap
i `
Aefflitional wor R o Me pert.orM Un er t Perini -c ec a t a app y
Mechanical Gas Tank Gas Piping Shutters —Windows/Doors
r Electric Plumbing _Sprinklers _Generator _Roof
Total Sq.Ft of Construction: 14 60 Sq.Ft.of First Floor:
Cost of Construction:$ 4,g 5P•9DO Utilities: Sewer _Septic Building Height:
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Name Name.- kk r
Address: D ��nCompany: 1
City: State:n-L Address: 1?("*'
Zip Code:2: 2 Fax:
Phone No,
Zip Code: !{ . Fax: 3 -to
Wall: __ Phone No.
f=ill in fee simple Tithe Holder on neat page(If different E-Mail:
from the Owner listed above) State or County License:
if value of construction-is 25M or more,a RKOR TED Notice of commencement is required.
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DESIGNER ENGIN ERRI
�Not Applicable MORTGAGE COMPANY: Not Applicable
Name'. Name:
Address: Address:
City: State: City: State:
Zip: phone: Zip: Phone:
FEE SIMPLE TffLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone.
OWNER/CONTR CTOR 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.
5t.Lucie Countymakes no representation that is ranting a ICE
will authorize the ermit holder to build the subject structure
which is In conflict with an appltcab a Home Owers Association rules,bylaws or an covenants that may restrict or pro ibit such
structure.Pleaseconsult�rvyith your Home owners Association and review your deed or 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 Re rd a Notice of Commencement may result Inyour 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 o r Notice of Commencement.
Signature owner/Agent/Lessee Slgnature.of Cp or/License Holder
STATE OF FLORID STATE OF FLORID
COUNTY OF COUNTY OF
The for9bing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ay of 26JU bythisfrday of�C ZOby
LaCd=k_ caa�mw .---
ame of g n acknowledging) (Name of KIM acknowledging)
(Signature of Notary Public-State ofFlorida) (S gna ure of Notary Public-State of Flort a)
Personally Known sELtr Personally Known "
�EBO Type of identification p DEBORAH RUSS
Type of Identification P dt�'�•�• ;IM4-
,•� ;s ;��, Notary Pub c• a
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Commission No. Scion jf FF 179630 `CommisSion Np. r yComrsjt—s`sCorf 0 FF 179630
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
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