HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:--,�� " I � � � Permit Number: � 1
r • ii M RECEI7D ''3 04 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
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PERMIT APPLICATION FOR: .
PR(JPt�SED INPRtUE�fi'JIEti3 LC3A►TiC3N. = +� � � Wk
Address: a nn
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Legal Description:
Property Tax ID#: -7 Lot No.
Site Plan Name: Block No.
Project Name: l er-1t
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRWTIO�N OF WORK S
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CONSTRUCTIQIU INFORMAT}IQNa
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Additionalworkto be performed under this permit-check all that appy:
Mechanical —Gas Tank Gas Piping Shutters T Windows/Doors
_Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ®C7 C�_� Utilities: —Sewer _Septic Building Height:
OWNER LESSEE•k ,1 t CfJNTRACTO
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Name Name: 1
Address: ,a r `0 Company: i t
City.7d b-ct S}'( � ', State: F (L Address:
Zip Code: c Z Fax: r— City,DELC-�- State:..
Phone No. 0 7R-- �W+L( Zip Code: S4g Fax:
E-Mail: Phone N�`2� sn
Fill in fee simple Title Holder on next page(if different E-Mail: a4 t b
from the Owner listed above) State or County License: $I
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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E SUr.P,7P,AL CINSTR k ItJi :IEI V1�1N �+2 tMArTt Nt
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
F Name: Name:
k Address: Address:
City: State: City: State:
i 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 AFFIDV'IT: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.
I 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.
p' 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
i 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
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commencing work or recording o r Notice of Commencement.
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Signaturedrbwner/Agent/Lessee Signature of Co or/License Holder
STATE OF FLORIDA. STATE OF FLORIDA
COUNTY OF COUNTY OF �� Ltl cie,
The forgoing instryMent was acknowledged before me The forging instr ment was acknowledged before me
this day of 2t7�by this day of�V& 1_ 201i_4by
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(Name of per+r acknow ) (Name of per o ackn )
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(Signature of Notary Public-State of Florida} (Signature of Notary Public-State of Florida)
Personally Kn OR PGtWft9RUWWatloni Personally Known gduced N@W,&"ELL
Type of idents uc Public-8tit of fiocid; Type of Identification Notary Public-Sate#fFTor
s Commission N -
omm Itsion
Commission } M Comm.@xplrr�� 11,2020 Commission No. 'N� ¢� My Co eE�c fres Mar 11,20210
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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