HomeMy WebLinkAboutBuilding Permit Application All APPLK(ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 't
Date: \V� Permit Number: 5-3
rt RECEIVED JUL 1. 8 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 Residentialy
PERMIT APPLICATION FOR:
PROPOSED PR EN
Address: t Q (IJCO"A4
Legal Description:
Property Tax ID#: CP \5-- ��.�J" ���-� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: f sr
� a
2GW A- t-Le c�
CQNSTRUCTI(}N INFORNIATION �
Additional wor to be pertormed under this permit—check all tat appy:
—Me anical —Gas Tank _Gas Piping —Shutters —Windows/Doors
Electric PlumbingSprinklers Generator Roof
— p — —
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ (� coo Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name Name:
_51 Y1Cc,Jn
Address: I)--? �-� Cia", (Z– -Company�T p_C&Ya- c. ap_C �–
City: �t6 Stater-. Address: gio^so '� �� Z
Zip Code: Fax: City: ,)csUl State
Phone No.77-72 –SIq —1 (7`7'1 Zip Code: 3 SLI 7 FaxffZl 7K_1_1-95
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License /-eQ2:) 20-74g,
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPtEIVIENTALCON5TRUCTION,LIEN LAW INFORMATIONr
- Applicable• ,:;- MORTGAGE ;
,v
DESIGNER/ENGINEER: Not COMPANY: _Not 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.
Signa V
of Owner/L ee/Contractor as Agent for Owner Sighre of Contract /License Holder
STATE OF FLORI A STA E OF FLO IDA
COUNTY OF S • �-y��'Z COUNTY OF
The for oing instrument was acknowledg d before me The fo�;going instr ent was acknowledged before me
this day of� ,201 by this\4�- day of 20T by
TN a\"s
(Name of person acknowledging) (Name of person acknowl dging)
-------------------
A
(Signature of Notary Pu ic-State of Florida ) (Signature of Nota blic-State of Floridae)
Personally Known OR Produce ti}ca�¢fl'tta 6 : Personally Known AQR=Prd�€ c � eAt 'ci6
Type of Identification pEP�\\ .S�a�o¢e16�61 Type of Identifi tion' ` o�asy pon�tXs�e 85a�6A
Produced �L ��— y y\1 aes e5a pss Produced Q Y N m"E EE pss�
, �No�at'1ou9��a�wua�No�a�Y
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Commission No. r'�. :M1 Go $ �N. Commission N = �' e��� Seal)
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REVIEWS FRO IJT 'ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNT R REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. /2014