HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
_ RECEIV'7D OCT 10 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:
PR0'P®SED INPROUEME�NT LO„�CATIO'N:
Address: /A O3 �(4 g a-ttf�-•�-�� �” rdz-�- p4gpc a r(_ 3Q !!;�Z
Legal Description:
Property Tax ID#: "a`� � �' Saa -� Cid a 5 dZ3d Lot No.
Site Plan Name: Block No.
Project Name: /
Setbacks Front Back: Right Side: Left Side:
fillilimm
D'ETAiI'LE� Df�SCRsI�PTION OF V110'R�K:
Cfl;NS�I'R�:I�J�C+�T�)0�1 tNFOR�MAT10'N':
Additional work to be pertormed 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: 1,150 Sq. Ft.of First Floor:
Cost of Construction: $ &I Z"'V:60 Utilities: —Sewer _Septic Building Height:
0, %NER 'LESSEE. t CO TRACTOR:
Name � ,G : 11� �'►ASelv[� Name:_, ���r._i�,:�, .
Address: 4S03'-1=F&Zell c.ico'' -1) Company: A. og
.t ,.. State: Address: ;_�-k.I Al
City: i-�r r ��.�r� �� yq-6"Li , ' i—
Zip Code: ��q�� Fax: City: 61 -
Phone
1 _ State:
Phone No. 5Z�5- 2S'L)C Zip Code: ' WS-S Fax:
E-Mail: Phone No 2172-�SZiSr�aco�.0
Fill in fee simple Title Holder on next page(if different E-Mail0'* t' f &
from the Owner listed above State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPFLEM'ENTAL CONSTRUCTION LIEN LAW INF®RMATION:
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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF <--)r. \-v c\k COUNTY OF Si'- 1-Oc N-'�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this\':S day of Oct, ,20� by this day of C,Se�t' ,20-\V—, by
C 00 O c ea,
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu ic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identif' �4Ns _ Personally Known OR Produced Identification
Type of Identifi tion ���Gts ° Type of Identific on
Produced- l.- �'soy Ns?°Z �ac� roduced tL_ ��` •
��GoM s,pe�Qoe<�Un / Mpp,\G G''G..•„ � `
Commission No. l ��p ,No�aN Commission No. GOM s�oI}c1e�
saw.pew �b;,oUn�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGE, ' k� TURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REV REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014