HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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:
PROPyOSED INPR4UEMENT LOCATIC?�ltL. � ' '
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Address: 6F �lbr
Legal Description: /��� 4i (//zU / /�4G�n h_zida �'
Property Tax ID#: i�`F �10• � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DE-SCRIPTIONrrOFWORK w � i
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Additional work to be performed under this permit–check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
SCElectric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ !�. ��(94 Utilities: —Sewer Septic Building Height:
# a3 $ a fi -
OWNER/LESSEE CONTRACTOR• � r
ti .�
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Name 44C Name: � /: r �oC/l0
Address: Company:
City: State: Address: ��`�` [ICJ b alIA-9 C�,r
Zip Code: Fax: City: State: lee.
Phone No. Zip Code: Fax:
E-Mail: Phone NoC7�_) 32-g7i3
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State o County License p
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJ PLEIVIEN�Ikill CO`N¢STK MR111I®N LIEN LAIN IN' ORM�►Ti;®. ',:
ER 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.
Signature of Owner/Lessee/Con r� for as Agent for Owner Signature of Contractor/Lic se Holder
STATE OF FLORIDASTATE OF FLOR��
COUNTY OF COUNTY OF
The forgoing instru e t was acknowledged before me The forgoing instrum n was acknowledged before me
this 42—day of 202 by this 9 day of 20/7 by
(Name of person nowledging) (Name o p son acknowledging)
r
(Signature of Not ry Public-State of Florida) (Signature of Notary Public-State of Florida)
"�•.,, JOS FRESNILLO
Personally Known nuc a i Personally Known '9 'eroduced Id0Wi!Rl�f1Mh0
` ° ¢"e � �ry 11 Riq °`P e`er Notary Public State of Florida
Type of Identification a ,._ Comm(sslon#FF 184850 Type of Identification ;s y
Produced :•° °zr =•a o Commission#FF 184850
�� mm.Expires Dec 22,2018' Produced
oFF�°.• ,, ¢ My Comm.Expires Dec 22,2018
Bonded through National Notary Assn. of F�
Commission No. S Commission No.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014