HomeMy WebLinkAboutBuilding Permit Application ALL APPLI BLFFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEP7nmk
DrDate: � Permit er: F,
IN RECEIVED
M ' t' 5- Building Permit Application AUG 8. 2016
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 1/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT IOCATiC�N
Address: O y �,vr.�.1�GYhtha�� Lorv�_
Legal Description: ���� ��u;.r nr.a .�� LG-I- ( C3. S o AL\
Property Tax ID#: 7SLAbA- b00 Co -Oo6 C-o Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETA4L�D DESCRIPTION C1F WORK
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R_e_oa.cp__ O r\ cS.sL o rre- e( a,,,
-10
COIVSTREICTIWtNFORMATlON _
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Additional work to be e orme un er t fs permit-c ec a appy.
HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
®Electric Plumbing Sprinklers Generator ❑Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $' J d�� UtilitiestSewer Septic Building Height:
Ofttk LESSEE CONTRACTOR
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Nameta a� S>1G ron Na�p
Address: rR-r 1A"CDC(e if S,c,�,'CgUAPWW1
City: &1r---- 1,i Qj't•2 State:At:' : ftAktrJfes' �u -� n�
Zip Code407-,,LR q J Fax: I / City: State.
Phone No. 917 - 372 ���, Zip Cot�e" q" .g`' ,� Fax:
E-Mail: Phone No. `7_1a—2110
Fill in fee simple Title Holder on next page(if different E-Mail: (_3,v--)cy":6\r c -@_C_0,,,CaS}• YC-A-.
from the Owner listed above) State or County License: (o�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAU1! 1Nt`ORMA1101t
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:
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.
S
_Sign Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of u s 20 & by this day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known i/ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. '— 1?6 S� .;"���' al) JASON M RAULER ONom sion No. (Seal)
.& Notary Public-State o Florida
„
Revised 07/15/2014 ,.•• day Comm.Expires Feb 28,2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
h
�;x iYt` 1` �11 f H TI I11Y � IYa7A�F' S a a
F
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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-
....................
hones_...................
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.
Si o ner/Lessee/Contractor as Agent for Owner Si' re of Co ctor/License Holder
ATE OF FLORIDA OF FLORIDA
COUNTY OF 54 - 1"4 r i- COUNTY OF !9k. 6-f
The forgoing instrum nt was acknowledged before me The forgoing instrument was acknowledged before me
this�day of v s 20� by this day of �u.s� E ,20 by
't%iYi
(Name of person acknowledging) (Name of person acknowledging)
(mature of Notary Public-State of Florida) gnature of Notary Public-State of F�` ' a)
Personally Known ✓ OR-Produced4entification Personally Known t, OR Prgdigcf ication
Type of Identification Type of Identification Produced is
Produced �� `�:';
Commission No. 'i~ '�;w I 01 �q8o Commission No. F�f 76 S5�/ , yo
.,,iii oil ` CC'YpLb/SAA c _�� ��D. 9�G
'y.Y�.'iii/+
REVIEWS FRONT ZONING { t1§ `'3'dl S VEGETATION SEATURTLE
.COUNTER REVIEW R ?8 6R IEW REVIEW REVIEW ".7a��a
DATE
RECEIVED
DATE
COMPLETED
eV.
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