HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATIOI.TQ BE ACCEPTED
Date: r( ' 11• rRI EC �' ``± '�' Permit Number: 12CAlJ
ti JUL 18 2-016 �+
M� a PEP.P,iiiTriNG
-'' St. Lucie County, FL
Building Permit Application Q
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 ko" v
PERMIT APPLICATION FOR: 41VA c, kCd1,ACC- "E
PRCLPOSED kN.PRO EME�NT LOCATI,Q;N:
Address: // �Li
Legal Description: O D / ` Y1 1p- 3 /`'l
E 3(`-�' --�-
Property Tax ID#: � �t�-�Q -- - U(> `L - (fid® - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
��T�AEI:ED DE=�5C> IIPT ®N: OF 1NOR
455(
S i v' 4) U [r e l - C>4
7K s Ok to
COS. NSTRUC I0N hNFO ATI;ON':
Additional work to be pertormed 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: -, / 10 Sq. Ft.of First Floor:
7
Cost of Construction:$ 7 S-0 Utilities: _.Sewer _Septic Building Height:
Q=VVN�ER�LE�SS��E• CONTRACTOR:
� -
Name M 1-7f
F �X,A,6 IAJ AJ(,( k— Name:
Address: C WAV Company:
City: ea 91 S77 J- titic- State: Address:
Zip Code:'3y4,? Fax: City: State:
Phone No. '-�L /5- �g�` 1067) 7 Zip Code: Fax:
E-Mail: Aa&J AJ 0 0 6Aff i C_ eo r Phone No
Fill in fee simple Title Holder on 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.
..............
SUPPLEVOTE EN
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,theFloridaBuilding 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 your Notice of Commencement.
Signature
ner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOJUI?A STATE OF FLORIDA
COUNTY OF Lijiq_- vt, COUNTY OF
The for g ing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20Wo by y this day of 20_ by
(Name of person acknowledging) person acknowledging)
(Signature of Notary PuN!c-State of Florida (Signature of Notary Public-State of Florida
4
Personally Known OR Produced Identification, Personally Known OR Produced Identification
Type of Identificati
iQn. Type of identification
Produced
Produced
6
Commission No.T �'Otot o_ "Commission No.
10 (Seal)
\M
REVIEWSR NT-�'- 4' 1 SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
C UNTN' REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Key. IILU14