HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / �' J(t. Permit Number: Z&1 o• o ��o7
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RECEIVED
Building Permit Application OCT 21 2016
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:
PROPS„®SE,.NPROUEMENkT LOCATIOrN �' v. � a rh , .0 tc` # .: Vis' ;
Address: 5/03 5C c4 GvQa.0 t
Legal Description:
Property Tax ID#: Y G 2 �•�;�.-,dy2 3 —lJc _v Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additioria.l.-Work to be pertormed. under this permit—check all.that appy:
_Mechanical =Gas TankGa's Piping Shutters _Windows/Doors
_Electric _Plumbing --, _Sprinklers ?, Generator _Roof
Total $q. Ft of Constructions _ -45q. Ft.of First Floor:
Cost of Construction:$ Utilities: __Sewer _Septic Building Height:
CONTRA
OWNEER LESSEE �*
as�4 ' .F: ,
Name_ de e//% r.-,rl e..% .. . Name: 1/ e C-71-
Address:
-! tAddress: 5Y01 ca!,. r� a Company:
City:-_ f. P 14Z.2 i F-r State:_ Address: 53 , (w- e e,X
Zip Code:T!Z 9 F-Z. Fax: City: ! 7 . r;{it e State: 1;0-/
Phone No. Zip Code: 7 Y 5 9, ` Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail STY 4 -" /•-a d
from the Owner listed above) State or County Licenseif value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUa�PLEM,ENTAI CQNSTRUCTI ON�LIEN'rU�W IN�FOIRMATION
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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 to obtain financing, consult with lender or an attorney before
commenpJng work or repdding your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signatu o Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDifl J
COUNTY OF ' '*?'r= COUNTY OF
The forgoing inst me t was acknowledge before m " Oi��S'`` The forgoing instrujpent was acknowledgeq bef
thi�day o 20 p by . xM th day of 20 L b m 3
$gam
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(Name of pLIrson acknowledging) (Name of pefson acknowledging) Q?�
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(Signature of tary Public-State of Vlorida (Signature o otary Public-State of Flori
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 SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW .
DATE
RECEIVED
DATE
COMPLETED
Rev. 7 4