HomeMy WebLinkAboutBuilding Permit Application All APPLICA�IBL INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l
Date: l Permit Number: \IVA-d34 0-7 1
RECEI'D SEP 23 2016
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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:
PRQPOSED INPRQVENIENT LO`CATIQN
Address:
S001 A
Legal Description:
Property Tax ID#: A-2�,V3 b'" �° 15 - d a3' �a--3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
(. el( r� - --
CONSTRUCTICIN INFORMATION
Additionalwork to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Co nstructio n: $ 8 -C) Utilities: _Sewer _Septic Building Height:
01NNERJLESSEE. CONTRACTOR
Name fls tri Name. (�::il, �, �.- -Don �v
Address:- 1' c iG� e Company: f-10 49 % k
City: - State:_ Address' LCA ��. ; �e 1;4
Zip Code: Fax: City: "' - �e: State: L
Phone No. -1`yc� 56 /077 Zip Code: w G'L�f Fax:
E-Mail: Phone No Za2 3DZ3= 47? 7
Fill in fee simple Title Holder on next page(if different E-Mail 17/, r'4Ws:Kl'l 6-
from the Owner listed above) State or County License FC-- 1VoZ9,-5C r]
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPRLEIUIENTAL.C4NS1"RUCTION LIEN LAW fNf=ORMATtQ.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 thepermit 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.
I )J� GJ XJVV
Signature of Owner/Lessee/Contra6or Agent for Owner Signature of Contractor/Lic a Holder
STATE OF FLORIDA STATE OF FLOJMgA
COUNTY OF ��. k—y C�� COUNTY OF
The forgoing instrument was acknowled ei before me The forgoing instrument was acknowledged before me
�
this'43 day of � 201 by this�� day of &o, 20J by
(Name of person acknowledging) (Name of person acknowledging)
vU
( ature of Notary Pu c-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Ident'
Type of Identificatin Type of Iden ' iLcation •""N. SEAN MpR�E�X023
Produced lrE Produced o NA3.va#
r� R1EG��,023 ��'•, .•.�F pIpIRES:�m ��eNrt}ters
Commission No. ��� � I NP ONiv Z02o ommission No. _ 9dTwu
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REVIEWS FRONT 016PERVISOR PLANS " VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014