HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:-T /QQ a
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:
PROPOSED INPROVEMENT LOCATIQN
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Address: rlr 1) EVA A v c-
Legal Description: CYYX-)fN4 Q,o,1, S ttll�
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF U1%ORK
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Cdl\ls' UCTlON INFORMATION
Additional work to�be pertormed under this permit–checkk all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric. _Plumbing
�,[ _Sprinklers _Generator Roof
Total Sq. Ft of Construction: O 0 I Sq. Ft. of First Floor:
Cost of Construction: $ 5 �S �� �J Utilities: —Sewer —Septic Building Height:
OUI%NER%LESSEE ;y ,. _ .. § CON TRACTt?R: {` `
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Name Awyml 7' � hfilOAl Name: h \
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�AddressEL> /Ullry� �� Company:
City' &A'' ` State: Address:
Zip Code: fax: /? City: LOte:
Phone No.� Z"�,� �7 D / Zip Code: 7
E-Mail: Phone No 77 Z4 r7r
Fill in fee simple Title Holder on next page( if different E-Mail a _ e veY3
from the Owner listed above) State or County License' l
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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� PPLEMIENT ►L Cr�NSTR,�1001 :+N LAW I.NF4R11IATION '
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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
comrr)lencing Work or recordin your Notice of Commencement.
Sign afur of Owner/Lessee/Contr for as Agent for Owner Si tune f Co actor se r
STATE OF FLORIDA ATE OF FLORID ) vn
COUNTY OF COUNTY OF fl�
The forgoing instrument was acknowledged before me The f going instrument was acknowledged before me
thi&L day of VQ,b 20 by this�� day of �w 20 by
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(Name of pers acknowledging) (Name of "erson acknowledging)
nat re of Notary Public-Stat;+f Florida) lll`\Si tune of otary' Public-State of Florida)
Personally Known c d Identification Personally Knowny OR Produced Identification
Type of Identification �.�SpRYAv., Type of Identification
Produced =?°F ;`�; 71HGRAM ProducedPa,. S.,y,+.� � e�•`Miles
of y`• a t • .• , .sN. My ComFlorida
,+ omC tr , . �ot Public-Statea1FCommission No. "o OFF�0�0�` CO20,2018 Commissil No. ,177249 ` - mis'�ion#GG5183rootar ''•,� m�9� ��.° Exp7Ye5d113012020
_. Notary OFF% i
REVIEWS SUPERVISOR PLANS VEGETATI.Otic,. .,SEAT}URTI: ,:,� sMANGROVE
TaT REVIEW REVIEW REVIEW "REVIEW � � -,REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014