HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z 1 l „' , Permit Number:
RECER":D NOV 2 8 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: 16 4 �
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ri'._ nr.-cam _ �.
Address: lC) a�\ ',� yN
Legal Description: VC.A- CX � Y V,- 1 V� OT Q
Property Tax ID#: I ?nt -" 15 - 61 CJ�� wo - Lot No.
Site Plan Name: Block No.
Project Name: _J Oc— Qyboate-�
Setbacks Front Back: Right Side: Left Side:
7C 90=110590
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itiona wor to a pe orme un er t is permit-c ec a t at app y
Mechanical —Gas Tank Gas Piping ^Shutters Windows/Doors
Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: /� Sq. Ft.of First Floor:
Cost of Construction:$ 500 Utilities: —Sewer _Septic Building Height:
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Nam C- Name:
Address:U{TOYI \(2 k- Company S`" —Clhk", `RS'c�Cl1�C�1C� lrl
City: State: E Address:q46 \IA!ON6106, Poie—(SNt f �
Zip Code: &-kgq J Fax: City: ofty
vmd State: N--L
Phone No.�-1 -
A 06 5� Zip Code: � � Fax:
E-Mail: Phone No �� - a - �JQ L9
Fill in fee simple Titk Holder on next p e(if different E-Mail � S foo
from the Owner listed above) State or County License' c e+ Z �Sq L3�
if value of construction is 2500 or more,a RECORDED Notice of Commencement Is required.
SlPPLEMENTAL Cf3NSl'RUCTION LIEN LAW 1NFORIVIATIC)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
commencing work or recording our Notice of Commencement.
Signa re f 6wnW Lessee/Contractor as Agent for Owner Signature of Contractor cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 0,r COUNTY OF ,r4kAY_ -
0 11
The fo'ng instr ent was acknowledg d before me The forgoing instru�ent was acknowledged before me
this day of �v 201,& by this f day of v V 2011, by
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(Name of person acknowledging} (Name of flemn acknow(ddging)
JL A�o
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(SignatLWfttsajr
�Public-State of Florida} (Signatu o Nuary lic-State of Florida}
Personally Known/ OR Produced Identification Personally Know7i_�__ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. FF-R4-1`5,CL (Seal)
TIFFANY LOBO
1SSi �97'1566 "= W COMMISSION#FF197566
REVIEWS FR $ f I NS 1� PLANS VEGETA ,S EkJW9ff9FFebrjdWM tR@ E
CO R Feb ark REVIEW REVIE iaaia�,153REVl (aallos�ry ryFIEW
DATE
RECEIVED
DATE
COMPLETED
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