HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED //
Date: 9IATC /G Permit Number: A
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Buildin Permit Application
Planning andiDevelopmentServices SEP 2 6 2016
Building and Code Regulation Division
2300 VirginiaiAvenue,Fort Pierce FL 34982
Phone: (7721)462-1553 Fax: (772)462-1578 Commercial Residential t/
PERMIT APPLICATION FOR:
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PROP, ,®MED IN O E,MENT OCAT N" x
Address: Alle-
Legal Description:
Property Tax ID#: 420.1-CO -00/7- 000' Lot No.
Site Plan Name: Block No.
Project Name1: Lqkewoj, I`
Setbacks Front Back: Right Side Left Side:
DETAILS® DLSCR,IPTI,ON OF 1N0 ?K
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COQ S&U.CTIO =[NEIGRIM
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Additionalwork to be performed under this permit-c e :a .t at appy:'
_Mechanical . Ga's Tank Gas Pipin _Shutters _Windows/Doors
=L,4ctric —Plumbing —Sprinkler —Generator —Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ /4100. °O Utilit es: —Sewer _Septic Building Height:
®WN RR/LESS' E: ON RACTOR:
Name Name: Alln oL
Address: 7 J e Company: Ve o se
City:_mort P1 State: rZ- Address: q11
Zip Code: Fax: City: �o, JQietrc� Stater
Phone No. --.2 707- V8- Zip Code: 3VZ4�, Fax: 'a
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail 1/
from the Owner listed above) State or County License ;F(5 000-9%X h"
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
FS 121' EM-OWN: Rl1CTI0N LI:EN.LAU1/ IN,F`ORfVIATI®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 Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend too cing, consult with lender or an attorney before
commencing work or recording our Notice Comrp ncement.
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Sign t e of O ner/Lessee/Contractor as Agent for, 12r_ Signa r f Cont ctor/License Holder
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STATE OF FLORID moa STATE OF FLORID =
COUNTY OF ¢"X COUNTY OF Z
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The f r oing instr ent was acknowledg d before m ';� The for oing instr ent was acknowledg d before
this day of 20L_ by aees this day of -to 20 p by ¢�w
(Name of person acknowledging) (Nu6e of pYrMn acknowledging) =r�N , T`
(Signature of tary Public-State of Flori a) (Signature of Not Public-State of Florida)
Personally Known / OR Produced Identification Personally Know OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS - FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014