HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 i ' 0s-cJ
REC Ivr--b
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Building Permit Application NOV 2:8 2016
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 1
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.PROPOSED 1MRROVEMENT LOCATION
Address: 9/ 9 _ AC gS0AJ W A 1Avi Oif c(F &Off
Legal Description: CZA I J / v( ) (
Property Tax ID#: 40;- - —cjn a 7 -- O(D C) Lot No. V7,5
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
2 s L�l4 c r 0C)56; mpnC,/GJ
CONSTRUCTION]NFORMATION
Additional work toTeIrtormed, un er this permit-check a appy: 1777
HVAC Gas Tank ❑Gas Piping Shutters L122 Windows/Doors
11 Electric 0 Plumbing Sprinklers 1:1 Generator E] Roof Roof pitch
Total Sq. Ft of Construction: n- ''�� S Ft.of First Floor:
Cost of Construction:$ - VCO L AL���tilities:MSewer El Septic Building Height:
OWNER%LESSEE t ; CONTRACTOR:' _
;. .,..
Name �� �f Name: - ti �
Address: L Company: /�iU�S�r L� f�c-�i
City:, / ;Q
de: i 1,\-J tate: �l Address: 62d I 1,\-J c. -9/11 A l- ,,)I JG�
Zip Co — Fax: City: ���/ S� �G«� Stater/
Phone No. 7 l2 9o':72 73Zip Code: ,3LfTf13 Fax:
E-Mail: Phone No. 7,2 / —02 ,!?o
Fill in fee simple Title Holder on next page(if different E-Mail: u -,v C
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: -
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
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder .....4-';
STATE OF FLORIDA - n51
STATE OF FLORIDACOUNTYOFCOUNTY OF
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The forgoing instrument w s acknowledged before The f r oing instrument was acknowledged befo �e2S o
this"day of N CU , ,20Jk by �x�� thi day of�f, /T1�• ,20� by g mg Q
MCI' d cnm
2 m� wz=
L 11'1 wN= ALF
(Name of person acknowledging) (Name of person acknowledging) " 8�
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a51LAJ.1'f4 -1
(Signature of Vtary Public-State of Flo da) / (Signature of Nota ro
ublic-State of Flori )
Personally Known OR Produced Id n ' ication r Personally Known OR Produced I t'ficatyiqr�
Type of Identification N� Type of Identification (/v1 �A'
Produced vv° 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
V. //2014