HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLq INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: Permit Number:-(
%mar- - Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Window/door
PkOPOSED;INPROVEMENT LOCATION
Address: `E(old A217y5e � 2J1V CQ
Legal Description: ot%q --?)I ytr 6s;}-aJeS 5
Property Tax ID#: ZA07- •Coob -o IC)Ca• crop-2- _ Lot No.
Site Plan Name: �enfy2+"�' Block No. '41
Project Name:enY1?F
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF wORK x
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CONSTRUCTION;INFORMATiON
�Additional work tonGasTank
rtorme under tails permit appy:
HVAC ❑Gas Piping _Shutters Windows/Doors
11 Electric 1:1 Plumbing Sprinklers I Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 1 0 SO Utilities: _Sewdr'[]Septic Building Height:
,OWNER/LESSEE CO(VTRACTOR
4
Name -7YOrrias W _(b2.d1 ✓ -+4 Name: "t ��ffl2�fi
Address: '-4U 1 b So S-e- yCD I Company: .s5oC-
City: Fc-'(+- 'Pl U C'e State: FL ( Address: ao`kt ST
Zip Code: 3y c18 Z Fax: ( City:_T-T- _L,ycte(CA C'u State: 1'c.
Phone No. Rey C*V Fj -3(oE q ' Zip Code:X3312 Fax: 9 S' ')c1?,xjl7
E-Mail: Phone No. gS�{1��1Z�1
Fill in fee simple Title Holder on next page(if different E-Mail: `�C(M'I is -e fl' p arAuc f5 . c.oll-1
from the Owner listed above) State or County License: GL C u(_Vti 8ci0
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION:'
. �
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: r _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 thepermit 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
__strur..ture._Please-consult_withyouur.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
commenWg work or re1cordin our Notice of Commencement.
Si nature of Owner/Agent/Lessee i of Contractor License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF 6' -6\1'L�-C COUNTY OF Sf -
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this -7— day of ! 20®by this R day of200 by
11-vO m w 5 &Mn-f v d+
(Name of person acknowledging) (Name o erson k owledging)
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(Signature of Notary Public-State of Florida) (Sig re f Notary Public-State of Florida)
Personally o u ed Identification Personall Known aC OR Produ d ation
Type of id e t t�w`f�aRrod �7�KKKttt����'� Type of Identification Produ -,.el.CA
.. �l`••`s ��"tV-t3tRKtN �RA \e d1 F
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68MMlb§l0N
33205 Commission ctw� e1\c' 02 e, 0
Commissio :- ( `A -- gtg\ofl p s� 3. pss
��Julys,217 ,�,,+:.���gr �.: � � \t® 6c
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS I VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW I REVIEW REVIEW REVIEW
DATE
RECEIVED _
DATE
COMPLETED