HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � 'i�� Permit Number:
RECEIVED
UQ
,w.W ,., - ,,F, 4n�r Building Permit Application DEC 2 9 2016
Planning and Development Services _;;' ;T TING
Building and Code Regulation Division ci County; FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID#: y131 0;1 -0040 00- Le Lot No.
Site Plan Name: Block No.
Project Name: &)--e-e,*j -ood
Setbacks Front Back: Right Side: Left Side:
lrl p
NO
,P f- J`r ✓'i��
Additional wor to be performed under this permit-check all that appy:
—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:$ 5-. ()00. 00 Utilities: —Sewer —Septic Building Height:
Name1 1 Name:
Address: q01 6-j'-Pr'r21AI0e. Company:
City: Ft. E'icrr-t� State: ' Address:
Zip Code: Jtlggf Fax: City: State:
Phone No. �Q„3 - -357q.- t?'?& 7 Zip Code: Fax:
E-Mail: 1hJ1&,t_ 1190/'adJ0 UdnOl1• COM 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.
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
commencimwQrk or recording your Notice of Commencement.
4
-7
Signatup of Owner/Tessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO!M, L_U t, STATE OF FLORIDA
COUNTY OF COUNTY OF
The fo ing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
this mday of (OMW 20 by
this_day of 20 by
'PA laChOW]
,(M
(Name of pirson a-cknowledging) (Name of person acknowledging)
(Signature 4f)NotOry Public-State of Florida (Signature of Notary Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced Produced
Commission No (8000DANIELSON Commission No. (Seal)
DEC (I
MY COMMISSION#GG055134
(Beet)
COMMISSION W COMMIS
EXPIRES.:�OC 14.2021) 1
Bonded througt 1st State Insurance
REVIEWS FRONT --ZDMXG-- R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED I
DATE
COMPLETED
lev.712014