HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
CC OC-11
RECEIVED
Building Permit Application
Planning and Development Services OCT Z 0 2016
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential I-
PERMIT APPLICATION FOR:
PRQP®SEDINPR�UEMENTLO�CATINyr .' .f{ r Ami Y . " � � .
Address: )a 16 -314ay�.�odC� , >
Legal Description:
roperty Tax lD#: C,3 �q3t>g6b _0O6Cr 60(3 _ 3 Lot No.�
Si Plan Name: C14rua LTGL h4 S Block No.
Project Name: Cn e, H ist� ✓'✓!
Setbacks Front Back: Right Side: Left Side:
D'ETAIISS DES'CRIPTI®N OF WORK £;ref � a h X w k
7„ a N� a x s 2 x
r I&rn a aR?
Q
CONSTRUCTION, INF®.R.MATI®N h � a+ � s
& '6 ,dan ".. ��e.gl+ rNrK n=r-� - *at a �` z_ .. ..9a
Additionalwork to be pertormed under this permit-check all tat-appy:
_Mechanical _Gas Tank —Gas Piping Shutters _Windows/Dobrs= `
Electric _Plumbing _Sprinklers _:Generator Roof
Total Sq. Ft of Construction: gigSq. Ft...�of First,Floor:
Cost of Construction: $ V � � Utilities: _Sewer Septic Building Height:
OUI%NER'WRf LESSEE: #may � CONTRACTOR i ,
Name r / Name:
Address: � �. L�) juld� r Company:
City: �WPly State: Address:
Zip Code: Fax:' City: State:
Phone No.b _27D 3?37- eGj Zip Code: Fax:
E-Mail: c SAJAN d rLC,-,5001 a�i Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License
If-value of construction is 2500 or more,a RECORDED Notice of Commencement is required:.
SUPPL��(UI+E'NT��L C�N�5TR�CJCTLON �iEN tr4�1N II�:F�' RMA►TI'(��(�I . ' ,#„� � � < r
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 room's and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement,may.result in yourlpaying 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.
c
,QzSlg r tUPO f"Owni;Lessee/ ontractor as Ag r Signature of Contractor/License Holder.
STATE.OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged b� j The forgoing instrument was acknowledged before me
this day of 20� j�o o this day of 20_ by
2 XM m
o
(Name of person acknowledging) (Name of person acknowledging)
�N
(Signature of otary Public-State of F orida ) (Signature of Notary Public.State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ide ti i t'on 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
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