HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 -J�-(�o Permit Number:
RECEIVrD Aluu 0 6 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: ,
P;R'OPOSED INPROVEMENTLOCATION „ ,-
�a a
Address: 1 �Jv►v� "•,e, 9kv Ff Aet c !,
Legal Description:
Property Tax ID#: -)1�6 C'_ �0��1 _ X 11 ��� '� Lot No.
Site Plan Name: Block No.
Project Name: die;
Setbacks Front hack: Right Side: Left Side:
DETAILED DESCRIPTION777
OF WORK.- 4
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41,
'37'00 - vv-av` tS S,EEE
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CONSTRU`CTl'ON INFORMATION
Add
ditto a wor to a pe orme under t is permit-check k a that apply:
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:$ cSSS+�3 > Utilities: _Sewer _Septic Building Height:
01NNERJLESS;>=E ~CONTRACTOR
,
Name Name:
Address: �'�tJ ` +�►v -v Company:Z1
City: State:_ Addr s:'14VA
i<
Zip Code: ��t�l�3 Fax: i City: c-.A--c\k��GS� Stater
Phone No. `��� �� �q3.�j Zip Code:'"53 Fax:
E-Mail: t\d Phone No 46
Fill in fee simple Title Holder on next page(if different E-Mail1�,jt_, S e 00m a
Ad—
from the Owner listed above) State or County Lice nse (�'�4 1•�
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU J�PLE( IENTAL CONSTRUCTION.LIEN LAW INwF�RIVIATION
r� :
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 of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLOI JDA
COUNTY OF S COUNTY OF �5 A%
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this g day of 20� by this 5 day of � 20_1�p by
(Name of person acknowledging) (Name of person acknowledging)
w�
(Signature of Notary P lic-State of Florida ) r (Signature of Notary P lic-State of Florida) ,
Personally Known OR ProducedJA �6a��ibr��F10g Personally Known OR Produ�c� dIdNifiei`°on
Type of Identification` F o \C.S �ee°16. 1 Type of identification 'ry o�P S1ale 2
16, p16 ,
Produced �(L- �1�.. _s ac 1 p�EXP\cel�Eg6aa6 P55a• Produced L t!=�..,i y,� �`: ye5��1 4mhE.RP+ceS a5g�rn e
Commission No.
Commission No. � } = c°�"(Se�l)a\0�`
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REVIEWS FRONT14�"'`' {ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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