HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
a
RECE
i
w
r i
I b
4 G .
Building Permit Application g 2016
Planning and Development Services SEP 1
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
__XL_
PERMIT APPLICATION FOR:
PL ; POSED IN'RC+1lMEIT LOCATION ::F.�. _,... ... .. :: .
Address: S totk( WX_1 �� Ciyi
"t—
Legal Description: </NA1JPL91 ;LA(_ 7,adz! ?9
Property Tax ID#: z,5- 703 090161 0001,, Lot No.3_
Site Plan Name: Block No.7Z-5-
Project Name:,
Setbacks Front Back: Right Side: Left Side:
DETAILED(DESCRIPTION OF WQRK, 04
o.<
F S
xx
'f b cP0L/VQ v G S LtW-&-L65 A2gr) ftj S'Z� , 5 trW&LJ&75 0 N Z�
coN
STRUCTION INFORMATION
Additional work to be per orme , under this permit-c ec all:that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric Plumbing _Sprinklers _Generator X Roof Pitch
Total Sq.Tt of-Construction: Sq. Ft.of First Floor:_
Cost of Construction: $ LI-ZOv Utilities: —Sewer _Septic Building Height:
OWNER%LESSEE C�?NTRACI�OR
Name LIi d AV S ewarz;r Name:
Address: Company: CASbua�, c-UVC-r La-C_
City: L State:PL- Address:32-7 l a
Zip Code:34i S'L Fax: city: _J)re-RzXg- Stater
Phone No. _51ol -7I(a 2_811� Zip Code: �qq9 Z Fax: -7-7-2- 4 L-(oCV,5-
E-Mail: I Phone No x')2-ZL(6 -SO4-7_
Fill in fee simple Title Holder on next page( if different E-Mail I�� i!!�,.6-04'4160.,e Lam.
from the Owner listed above) State or County License CCC.053'3"13 i IOZSi
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIjEN LAW INFORMATION
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 toaPrere�crd,4�
r perty. A Notice of Commencement must be recorded sted on the jobsite
before the first i If you intend to obtain financing, consult with r or an ttorney before
commenci A w rour oticeof Commencement.
Signature o Ow ee or as Agent fo Signature of Con
® m
STATE OF FLORIDA < 2t X STATE OF FLORID M-<
COUNTY OF COUNTY OF foo
mC M
The for ping instrument was acknowledged befor g= The for ping instru ent was acknowledgj by
this day of 20/1, by �'° this day of 20/� by
+
(Name of person acknowledging)� (Name of person acknowledging)
441d_1A_
adZad4�
(Signature of N&tary Public-State of Florida ) V (Signature of Not/Pub ic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.