HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED
Dater 1 Permit Number: ��o '�czzl
RECEP : 1� " 012016
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
PERM ITAPPLICATION FOR:
Address: rpo0 *PP1�i'C-04 Baca; rni Txf-'rcf', "FL.
Legal Description:
Property Tax ID#: 39 10 - 50'3 000-0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: LeftSide:
ME I
C�o n rie'-ii)t 0l� (a -6n h e(41 r tj W I'
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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: Sq. Ft.of First Floor:
Cost of Construction:$ 3Coco Utilities: —Sewer _Septic Building Height:
Name Jn n ll 5e44cn Name: �5
Address: &07-I1 ,ill4,r, ,�04. Company: jo-4 C�jqill q-1. � VA L U-L
City: i=+n-r-i Pierce " State: - Address: 5yaa NW Cr&-rvley S+
Zip Code: 34q RQ Fax: City: 2=4 S-' Lyr,y-. State:_&-
Phone No. 92!�L- qQQ Zip Code: 3`018(v Fax:
E-Mail: Phone No -77a- qW0 -g373
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License 2�032(/J
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
IIDESIGNERANGINEER: Not Applicable MORTGAGE COMPANY: V 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.
!.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.
Sognature a Owner/Lessee/Agent Signature of ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 1S F
The forgoing instrument was acknowledged before me The fo�going instrument was acknowledged before me
this day of '20,% by this day ofd '20� by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary blic-State of Florida} (Signature of Notary P lic-State of Florida)
Personal) Known OR Produced Identificaf 'r Personalty Known OR Pira uced ldentific�as pp1�VAN$
Y ` H c a DEAN R.
Type Identificationof. t)EA��A Ca e 91��or;da +Type of Identification i „"a�,,, Public.state'oi'�lorsd
Produced L Q� Y P Notary
Produced --My Comm.Expires pec 16,241
PU&C6,201 C _ « .:
Y P,Ja Nalary tires Decc g1 = m ssion#EE 858761
pu r ,r m EXP X5$7 As n.
Commission No. =M'(§e� s+on#EE. tory AsrlommissionNo. s`(,� =� �� ugnNationat Notary
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REVIEWS FRONT '26'NING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED _
DATE
COMPLETED
R-ev.7/2014