HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF MUST BE PLETED FOR APPLICATION TO BE ACCEPTED(. .. O
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Date: Permit Number:
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Building Permit Application
JUL 2 9 2016
Planning and Development Services public 1p'o:ks
Building and Code Regulation Division St. Lucie Couray, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR®�POSED INPR�OU MEN LOTION;
Address: 313 Paroa,,�d 61yd
Legal Description:
Property Tax ID#: 2107 0- 013ccr— 00 0 —77 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET7AI"LED1 111— RI'PTION OF WORK:
i S4a l l Wal+ '` [i1n t., lD Cs,,4 e c4
G NSTRU'CTION IIN,,R M7
Additionalwork to be pertormed under this permit-check all that appy:
_Mechanical Gas Tank _Gas Piping _Shutters _Windows/Doors
��PlumbingElectric _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OWNER LE�SSLE: CONTRA OR
,., l .
Name w ^ Name:
Address: 13112
vi L-14-- Company:
City: '1_64 (l2/ce_ State:LL Address:
Zip Code: 3���� Fax: City: State:
Phone No. -7-7>_- 260- Zip Code: Fax:
E-Mail: Ar 0A'9)R Q cJ V-4 Phone No
Fill in fee simple Title Holde on next page (if different E-Mail
from the Owner listed above) State orCo ty License
if value of construction is 2500 or more,a RECORDED Notice of Comm e ment is required.
S ININ E ;ENTAL CONSTRUCTION L°fE`N LAW IN" F�RMATI N:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
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 of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA A STATE OF FLORIDA
COUNTY OF COUNTY COUNTY OF
The forr .
ing instr ent wa ckno led efore me The forgoing instrument was acknowledged before me
this
lay of 20L,0 by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of oar ,u ic- (Signature of Notary Public-State of Florida)
a
"A960 F
ter°* ,`�; Notar Public-Stale of F orida
Personally Kn *.'_ N t lic- t i�tio Personally Known OR Produced Identification
Type of[dent i" o`�My C m. tyres May 27,2019 Type of Identification
�'�O F` Produced
Produced ''��� �� nded r nal Notary Assn -
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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