HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
� ..+%ra �x' " � a�c�,^ f4•a�-a � ;_fit
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 LOCATIONr ,.
�:.
z
Address: 13 NI 41etJb& 91vW ,�e�SPh Se4G4, 3V9`J..sr7.
Legal Description: P ZY le T• 14!h w {�JL• 72 -��3Q--3 507 22 5 1- '3'9.2-3
26903. 392 -I)
Property Tax ID#: /V 51P2 - 5-0) v /5� y F- 000 - Lot No. /5
Site Plan Name: /�'eAlf Block No.
Project Name: )`.,4,,
1'? lT/
Setbacks Front Back:_ Right Side: Left Side: ...
E ', t z .. � a✓ �.z 3« - _ z + p� �.$£ �`' ,��� ty � r� �y a�nom.
DETAILED DE5CRIPTION OF WORK
N d s
f f
'14 11-11-"/Ori mac. "OM
.. Y
CON3STRl1CTIC+N INFORM .6
I+ITION7
r. 'a,'M�-3� gk-. '. R m .
Additionalworkto a pe orme under this permit-check athat app'y:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing
�/ _Sprinklers _Generator Roof
Total
Total Sq. Ft of Construction: Sp/ Sq. Ft. of First Floor:
Cost of Construction:$ /700.00 Utilities: ewer _Septic Building Height:
0�1NNER/LESSEE 4% CONTRACTORX
i Name F a (' d2? Flame:
:Address: 2 6/..I ��Pr- ��31� i V, � Company: 5,o YI o,.� 7"J(✓ -Z�
City: el f` ,j7? g et' State:A Address: c4 Z
'Zip Coife� l �"�'9 Fax: City2I fQ� P Gli State: 1cz
Phone No. ;7.241 ` •7.30- 7-7 Zip Code: Fax: 77,2 -,2132-2291
E-Mail: Phone No 77 "m
Fill in fee simple Title Holder on next page (if different E-MailCQ /7z< n��4�oae�oJ�
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU.PP,LEIVIENTr LCONSTRUCTION LIEN LAW INFORMATION
. .
., ...
DESIGNER/ENGI ER: ° _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ t Applicabl BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: e: Phone:
OW CONTRACTOR AFFIDVIT: Application is hereby made too in 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 rmit.
St. Lucie County makes no representation that.is granting a permit will authorize the �enants
r to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or andhat may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed ftions 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/Agent Signature of Contractor/License Holder
STATE OF FLORI �,G1//2 STATE OF FLORI �
COUNTY OF COUNTY OF &4,611
The g inst t was acknowledged before me The fg�gping ins ru t was acknowledged before me
this� y of 20�by this%`y�—day of 20a by
(Name of erson acknowledging) (Name of p son acknowledging)
a
(Signature of Not Public- a of Florida) �/ (Signature of Notary Public tate of Florida)
Personally Kno n OR Produced Identificationy Personally Known OR Produced Identification
Type of I e atio Type of Ide tif' ion
Produced ,
"��•�;�, AIMEE SHE IFF �,•�;;y��.,,
Commission#G ®ris n No. :°� AIMEE SHE IFF
Commission N :, , Commission#G 304
?•,f �,� My Commission Expires arc My Commissi n xph
��;,.� September 1 , 2020 Se tember 20
5C•A4MA}l
REVIEWS FRONT . ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER* REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.