HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE 74F MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 � (" Permit Number:
• , RECEI�'.-D SSP 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:
PROPOSED LNPR�UEMENT LOCATIa
Address: C-1)
�� II
Legal Description: PooL �� V tLl -TCL),< c
Property Tax ID#: 000 0Q® Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�S.GI2IPTION OF WQRK:
Acid
J
CONSTR�U'CT(QN INFORMATION:
itiona I wor ,to be perrormed 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:$—S �� Utilities: —Sewer _Septic Building Height:
O
ER�LESSE,-�� . �.• N�RA. •� .
Name Ci ASO Name:
Address 1 /jl ! Compny: - -•p '1 s
City: 1 �e State:�l� Address: �<7`l�``��:`:GY`✓I+�G.��
Zip Code: 3 9L/r'1 Fax: City: (Jf-C6State:
Phone No., A-A& loos Zip Code:29,�§C Fax:
E-Mail: Phone No 9702— 5--.? ct - 7
Fill in fee simple Title Holder on next page (if different E-Mail d"-r
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENT ,�CONSTRUCTION LI I EN I LAW 1'N'FORMATION
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.
r
Sign re of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA ,
COUNTY OF �5>': LSC \ 'Z COUNTY OF �-� ,'LUCK "
The forgoing instrument was acknowledged before me The forgoing instrumentw s acknowledg d before me
this<, day of S� 20� by this G day of S-� 20J(S by
uzo
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida ) (Signature of Notary P lic-State of Florida)
Personally Known OR Produced Ide ' ' ion Personally Known OR Produced t ='
Type of Identification tz�sr. 1?qz3 Type of Identification SEGO
Produced L tW�`" 'U�' 2a +, Produced L'D D uSSlON#x,023023 y
�0�bet 20 ,Mpj mbar 16.207.0 a
NC(QOM s: m bt�Vnaei� -'" pIFiES:Deco 11,� 0.1d.,eita�w
Commission No. � �cP� Commission No. —,U
�n
REVIEWS FR ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014