HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ���1, �� Permit Number:AR"M
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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:
PRNP S;=DI R®VE!MENT L®CATION:
Address: VS )Fn1f / (f/'G e cl, ^ �l PfL —� S
Legal Description:
Property Tax ID#: 3������"' a0y6�d60 "� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
®ETAILED DE•�SC I�PTION Of 1NOR=K:
e, aS' i L A--7
se GC
CONSTRIJ'CTIO"N IN`FORNI-ATtO'N:
Additional work to be performed under t is permit—check all that appy:
Mechanical _'Gas Tank Gas Piping _Shutters . -, Windows/Doors-;'
Electric _Plumbing _Sprinklers _Generator _Roof
J 11
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
O NER/LE--SSS CON1"RAC 0
NamName:
Address:. Sc�aS �_ pi.;C��; 2= �! Ud Com .an : 1
f � _ p . y. ��.. Lam,
S
City: State: -- Address:.]
Zip Code: Fax: City: /� e9S' StateyL�
Phone No. Zip Code: -3Y % SO Fax:
E-Mail: Phone No 77 Z 2
Fill in fee simple Title Holder on next page if different E-Mail �
C,�O G 9-�
from the Owner listed above) State or Cou ty License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPtE�MENTAL C®NSTR+U'As IT,1TIN NLIEINS LA1N INF®RMATIO!N:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Nov pplicable
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,screenrooms 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.
Sign ure of owner/Les ontractor as Agent for Owner Signature o ontractor/License Holder
STATE OF FLORIDA STATE.OF FLORIDA
COUNTY OF S COUNTY OF Sk .
The forgoing instrument was acknowledgd before me The forgoing instrument was acknowledged before me
-�
this day of�gjZ !: 20� by this day of Sl— ,20Aa by
�vw•�S L�a � � •n.e � L v,n, cf�
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu c-State of Florida) (Signature of Notary P blic-State of Florida)
Personally Known OR Produced Identification Personally KnownIdentification
e of IdentificatJZt��J
Type of Identification P pEANNAMARIEGNProduced L pEgNNpMARIEGNENs oduced ` ? M1'CO ENS
"s;:F. Po' EXPIRES:p ION#GG 022023 ►
MY COMMIS510N#GG 02202 ecember 16,2020 14 Commission No. LS6'�6 r; (S PV RES:Dewmber16,2020 mmissionNo. �� , ° �Nc� jwnderv�,;:;.; +
o?•' Bonded ru Notary Public Undenvri rs
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014