HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFONLIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '1 1
Date: Permit Number:
RECEIV'-7D JUL 14 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
PERMIT APPLICATION FOR:
,P 0®S D IN,P�ROVEMENT LOCATIO ' :
Address: B65-0 S OCEAvo b e I Vr Tt=o S'FirV miACl-1 FC. 3�QS UNl 1
Legal Description:_rME X q , ,4-v-,)b DoLNF S (DP
Property Tax ID#: 3s3'1 SQ ) �7bLi OOD -- y Lot No.
Site Plan Name: k6k&64 T_5�-A jb luNr� Block No.
Project Name: I.A P10 ZF._S 14JEy XE_
Setbacks Front Back: Right Side: Left Side:
BA7dRw4ag KEm od�E L N Ew Tr t- sil—c)n
ONNSTR,UCTI.O=1N MATI,®N:
Additional work 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: ` y 5Q Sq. Ft.of First Floor: 2,2 5 `
Cost of Construction:$ Z Utilities: —Sewer —Septic Building Height:
OWNER/LE�S�S CONTRaA �0 :
Name .34L_ I-AP)o Name: DANY1 SVV) 1-1-14
Address: '865-0 S OL KJ IM UA !— 903 Company:bVIK4 5M CTH 4-56A6 LC
City: _ dU5EAJ RF,AC d State: FL Address: /)III Sw l3UC�S�lry %�
Zip Code: 3�14� Fax: City: �TUA 2 J State: FL_
Phone No. Zip Code: _S19 Fax:
E-Mail: Phone No SZA/— SH&- 202 44
Fill in fee simple Title Holder on next page(if different E-Mail LAVA AAjf- -b"560 A0_1 C'oM
from the Owner listed above), State or County LicenseC,61 151? 333
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION 111EN LAW INF®RMATION:
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
commenQing Wqrk or recording our Notice of Commencement.
Signature of O ner/Lessee/Contractor as/gent for Owner Signature of Contr c r/L en a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S'r L- COUNTY OF S'�-
The for oing instrument was acknowledged before me The Q� oin instru e t was acknowledged before me
this\M day ofy` ,20NG by this `Cg day of 3 0 20� by
(Name of person acknowledging) (Name of person acknowledging)
_ 6
(Signature of Notary P lic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produceci;Id��r�iP[���tfofl � Personally Known OR Produced Identification
Type of Identification DEK gtate°t�1 '0 — Type of Iden ' ication
Produced '��- public pec 16,2 Produced t- L�, F..1a: GIVENS
,,\ "e c�at�ty in Expires EE 858761 Mate of Florida ,,
My Goth Sslon# al Notary P. r> P UjN Lary Public c 16,2016
Commission No. "1 C°me� NaUon Commission No. a — G°mm Ex t���8587
t d 61
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REVIEWS FROINT_ ZONING SUPERVISOR PLANS V E G E rATlON�`� EA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED _71
DATE
COMPLETED
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