HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /�7t/'7 Permit Number:
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:
PR®P®SE NPROVE ENT LOCATION:
Address: 73,d,7 fieW-d Rnh�es g0yW
Legal Description:
Property Tax ID#: (D41, 401 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCR,IPAT,ION 4f WO'R+K:
fin
Ali' G� 'fie Gi
C«ONS RUCTION INS TION:
Lit4-echanical
ion wor to a pe orme un er t is permit—c ec a tat appy_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: $ � ��� Utilities: —Sewer —Se ptic Building Height:
OW'N'ER/LEs%7 ICONTRACTOR:
Name:
Address: .77 !�� Company:_
City:116,4 State: Address: 4u�/CrJ%��:
Zip Code: Fax: City: I/�✓/i /3::,," L4 State:,��
Phone No. 601A(60 `r��"� 1��� Zip Code: Fax:
E-Mail:tq 4—d cen Phone N —7`11
Fill in fee simple Title Holder on next page(if different E-Mail d' , 7
from the Owner listed above) State or County License 6
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPFLEMENTAL C«ONSTR�UCTI®N LIEN LAW fNF®RI�/1=A1'1®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.
gnature of Owner/Lessee/Contractor as Agent for Owner na ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF COUNTY OF S-�. L\3<,\
The forgoing instru e t was acknowledged before me The forgoing instrument was acknowledged before me
this-_day of 2031 by this 1 day of 2011 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub k-State of Florida ) (Signature of Notary ublic-State of Florida)
Personally Known OR Produced Id Personally Known i
Type of Identification OF N SSM�IF-G p oz3 Type of Identification ;�.'N.M,: DEANNA MARIE GIVENS
Produced Produced L - : • : MYCOMMISSION#GG 022023
W.2020 „ EXPIRES:December 16,202.0 l:
�: •�•*. fy,PIRES:December Undervrtiters "'°°'' Bonded ThubUc Undenwh!'s f
Commission No. dedshm Commission No. �€ l
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW'.. REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.