HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 Permit Number: O �� 0,?
F %H:. ^n—• "ar R - ;. ,y _557F
AUG t 7 1016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2306 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
R POSED INPR®XBM ,N
Address: :1 I
Legal Description:
I
Property Tax ID#: 031 AW T Lot No. 1
Site Plan Name: - Block No.
Project NanI Sndca n ly e-r
Setbacks ' Front Back: Right Side: ? Left Side:
®ENTAILED DES�RIPTL®.N F 1NORK�.
J�nTA,LL 4PY DE E
=`I �a_ff f_5 V)ALK - 4TE 1-4WALK 64 TC
CONS�TR!11CT10' NEORMATIOINTONI 1 10 M211 W11111lift AIs -
Add Itioria[Work to be pertormed under this permit—check all t at'app y:
_Mechanical Gas Tank _Gas Piping _Shutters =Window's/Doors.
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 200D . Utilities: _Sewer _Septic Building Height:
Name Name: }
Address: 54 (6 RpLA p4nm r>R, Company: Vbj MADU:5/yS
City: State:_t , Address: )W,5WI d14a.-
Zip Code: �1 Fax: City: PC ��' �_I)c�E Stater
Phone No. Zip Code: 34i 53 Fax:
E-Mail: Phone No 9111"10 1 Cl403
Fill in fee simple Title Holder on next page (if different E-Mail hv\ 5 636'6 OqV&. Gx-Yq
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJRPLE'M'ENTAL C®'NST1R-11 TION LIEMIKE IN:FORMATI,®'N
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 Comimn cement must be recorded and posted on the jobsite
before the first inspection. If you intend to Inancing, consult with lender'or an attorney be
coMMencing work or recording our Notic encement. >_:»�•,
f so`
Signature of Owner-/Lessee/Contractor as Agent fr > g� 'Signatu a of Contractor License Holder m
om.
,2 mE.�o - moo
STATE-OF FLORIDA_ _ - — �'�� STATE OF FLORIDA 2 339
iis2� � o ;
COUNTY OF' - 9 Z COUNTY OF m
The fo going instrum t was acknowledged befor rR'eo � The forgoing instr nt was acknowledge befor D
thi4�day of 2014 by `°N this day of 20/to by 1:2 ifi Q
R-w N
N
(NameA person acknowled ing) (Name of pers acknowledging)
( ignature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known /OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced j Produced
Commission No. 1 (Seal) Commission No..i (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION -SEA TURTLE MANGROVE
COUNTER REVIEW` REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014