HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: II J �9 Permit Number: /I., d�
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- Building Permit ApplicatiOAL 16 2016
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 A PLICATION FOR: 11 .�( zSS, rA�+ �
PROPOSBD I!,N,! R,O„VEMENT LOCATION:
Address: /304 1,� Y,Aw F6 T EL 3 z/ q_-f
Legal Description: &4 - wa; t,.1� - U� / /�Ck /�'� /4�(M �3//�,�D�('3G�z/-&9
Property Tax ID#: 130- 6o)-072-,. Doo Lot No. /Z/
Site Plan Name: Block No.—9
Project Name _ iQe_.Pc�;. j)✓1/`2
Setbacks F font ` Back: Right Side: Left Side:
®ENV ILED D'E�SCRIPTION OF ORK:
po�21 �i '- l zr� �� ��� - �,•. Ny . bio'/ ��-;� ` �� I
I
TRUCTIMN I IN.0PFA"TfON:
Additional work to'be performed under this permit-check all t at.app y.
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator —Roof a O)ei vF• W'q
Total Sq. Ft of Construction: /.ffr� Sq. Ft. of First Floor:
Cost of Const ruction: $ �� �= Utilities: —Sewer _Septic Building Height:
01NNBR/'LESSEE: _ 'NSR CTO:R:
Name (i-,14AZAyFi42 SA-"--F,0 Name: [p 2�� �C>7�p,tf Z,
Address: I S2-o/ Mteo fil-fl CW- Company:
City: t;t- e.rz-• State: GL Address: 2 (o 1 ►/ct,�e„o'k L AAe rF i 5:z, `96
Zip Code: 309° Fax: City: �aK Stater(-
Phone No. .I '7 7 Z - 35-9- 3�3� Zip Code: , ct ue,� Fax:
E-Mail: '2GL�}�z'►ed 7�[J c„ ►r.ch.Q• c�,u. Phone No 7 72- 1-16 - 0.Ss3
Fill in fee simple Title Holder on next page (if different E-Mail n
from the Owner listed above) State or County License !7
If value of coistruction is 2500 or more,a RECORDED Notice of Commencement is required.
MEMx "
S�lJ3PPLE�MENT�AL CONST RUCTION LIEN LAV1/ INORI�/1ATI®Nn:
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 thepermit 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.
_o. .r_
Signa ureo caner/Lessee/Contra r as Agent r., ura3r Si at re o ontractor/License Ho
m
STATE OF FLORI6 - a MM STATE OF FLORI M,c
COUNTY OF moo= COUNTY OF -°29
cnc 12 Cn co
The foqoing instill nt was acknowledged befo E m The forgoing in t was acknowledge bef rig
this day of 201 b by FZ- this/&day o 20/6-by �T
�T Ym
N
H=
m yA<
el� / � ✓t.
(Name of p rson acknowledging) (Name of person Aknowledging)
( ignature of No a Pu -State of Floridg) (Signature of Orj Public-Stat of Flo da )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014