HomeMy WebLinkAboutBuilding Permit Application Ail APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��Z9_ �� Permit Number:
R E C E I V D JUL 2 J 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: �� c� f
PROPOSED 1NPROVEMENT LOCATION:. y
Address:
Legal Description: So j L y c i -k 0ja2A S/,0 c4 j') L h o42
Property Tax ID#: `i 2 g - -1 o2-- I I G 7 - Czp m4 Lot No. 21
Site Plan Name: Block No. 55
Project Name: L
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION QF VIJORK•'
S �T
�. 72
CONSTRUCTION�INFORMATIONJl
Additional work to be pertormed under this permit-check all tat appy:
—Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
4Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$_A00 0� Utilities: —Sewer —Septic Building Height:
01N;NER/JLESSEE CONTRA/�CTOR
Name C l� �- e �+� L_ C� I'� e� Name: 17�G�•ecla� f'6er 1L TVavG/0ye,u�z1)
Address: 2'l [ Sc2� G �o�`c 4� Company: l�«YP���a
City: �evS Stater Address: q'706 E,� m 44�
Zip Code: 3 L/g/ 46 Fax: City: (l- f l f v s=e Stater
Phone No.e-1� I- 3 Zip Code: 3y 4 Fax:
E-Mail: Phone No '7 '7 Ll 6 c- -t'(Z j I
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License 6:- C 13 00 �-Z-
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
ksup,F�LENI NT,AL COIUS ReCJCTION LIEN LA1111111G ORMATlO � g
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
commencing work or recording our Notice of Commencement.
Signature O er s e/Contractor as Agent for Owner Signa re f C tr ctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S-C- COUNTY OF .
The forMoing instrument was acknowledged before me The oing instryment was acknowledge before me
this"v�v1 day of���3�� 20� by this day of Jy �Y 20J by
(Name of person acknowledging (Name of p rson acknowledging)
(Signature of Notary Public tate of Florida JSignature of Notary Pu lic-State of Florida)
Personally Known OR Produced Identifi a as IFNs o�a� sonally Known OR Produced I ti ip
Type of Identification � , p PNNP S�a � oe of Identification ,� `�EpNNP' °ot F\oc'da
�6, G L � \ic S
Produced L ora y�'"e\��" esoec , Pro luced \ l- �.', ,... r
EXP�� E9�a ssa ° Q T4ubExPiCes�ec 58I
No\a y P � ����� comm #EE a
Commission No. ��` _°ti` { I} mm`o�9 NaCw°a\ i ommission No. L—`f ,„> ��'Myat�onalNota�y
,�-� � Zhc � `
o- aed sr' oma: gnnoed
REVIEWS FRONTZO'NIr G SUPERVISOR PLANS VEGETATIO q SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014