HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 111 Permit Number:
RECEIY7-0 IiOV 101.016
_ 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:
d
4PR0 QSED�IIPR01/EMENTLOCATIONR .. �`
}ri "s8-.��1.a fl ..,.oW, .waac- .. It uta vrJ,
Address:
Legal Description:
Property Tax ID#: ���d �$ " �d`y��d0 . Lot No.
Site Plan Name: hze.,4 6J _73feS &NolP dtiw ML,(nc� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
45 'R f
DEpTAILEDDESCRIPHONAOFEWORK -
� s � x
.rE9� hE" ?'� s.,.t'#{k .�k.sr.�" s*' �".4 -'i^.TM, Uai 7xw* er EYkt,S i.m.z+ •.1x. .a. ,Fa ..._:.. "ifs .a'?, ti xl .,.:.:,. -.xt°+,.'.x. x r
E 440 n QR V EW 4-Y A E4ST S",f L„lry A)rw Come
300o P Alerevesk L1 7'K�e1- fk 41x-i�
suM
} y - u g.
tom,
C®,NSTRUCTIOFAM4M0�QRNI'AT #Nr Nsy � .
Additional work to be pertormed under this permit–check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors 'VT
Electric _Plumbing _Sprinklers _Generator _Roof l�
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ obb Utilities: —Sewer —Septic Building Height:
o0U1ljNER%LESSEE - �" �:`
m
' .,sY � $'�rv.�AW .�.�-�. .: .Y w.,2e.d'33�n-,b a :. ..
Name - �., yn P r Name:
Address: '.o? Company:. ;' x'4,1_0 oii -
City: r L State:�L Address: -�'
Zip Code: Fax: City: �� �C State: f_
r P � .
Phone No. 77. NP-1I a a Zip Code: 9!1 (C -Fax::
E-Mail: Phone No 7 Q.1 �a
Fill in fee simple Title Holder on next page(if different E-Mail C&
from the Owner listed above) State or County License C
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
' Sl1iPP1.ENIENT I:.CONS�TR�C�TI®IU LIEN LAS I.N!FOR�I�A�T't0'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 to obtain financing, consult with lender or an attorney before
commen ' rk or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor.as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI A STATE OF,FLORIDA
COUNTY OF S�'• L u �� COUNTY OF S+. Lam« e
The forgoing instrum nt was acknowledged before me The forgoing instrument was acknowledged'before me
this\O day of%Z) 20� by this A day of �� 20XS� by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notaryblit-State of Florida) (Signature of Notary blit-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L- 1— ENS Produced L L
�E.GN, 023
Commission:No. D � #`GG6,202�•1e�s Commission NoK �NNAN �EGNSp23
GGM�to� decwn MMISStON 020
��5�e �b11e11e ? r' M`� mbef 16.
FXP NotaN �; z EXPI[�S Deee �Undervmler
:°• t3ry Pub
REVIEWS FR I`P^� ^'t NG SUPERVISOR PLANS VEG EA TURTLE MANGROVE
COU REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED-
DATE
COMPLETED
ev. 4