HomeMy WebLinkAboutplot plan All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ll
Date: Permit Number:climb
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_.. _ ...mm: 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 V
PERMIT APPLICATION FOR:
PROPOSED INPR \/EN/IONE
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ENT LOCATIN} "' `' �' k
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Address: n S L!vL J�g&ti, Ve I -v-
Legal Description:
PropertyTax ID#:_3-'19- sot-waoco / Lot No.
Site Plan Name: Block No.
Project Name: (f Otil c}e_, Dr5 V-9 WwM
Setbacks Front Back: Right Side: Left Side:
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CONSTRUCTION INFORl1/IATION�rry ' � NN
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Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
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Total Sq. Ft of Construction: tY00 Ft' Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
Name ��� ►'�w� Na'me:_
Address: tH 010 A% u K,iv2y Company:
City: -fi �iQ'r Cie- State: Z Address:
Zip Code: '_3 y y�''Z Fax: City: State:
Phone No. :? d Zip Code: . , Fax:
E-Mail: NV f o, yv�E'_�,+-o ko eXMA 1� C4-)N Phone No
Fill in fee si ple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIpN I.IE:N LAW INFORMAT!®11
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DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 far 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.
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Signature of nerJ LesseeJContractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF
The forgoing Inst ument was acknowledged before me The forgoing instrument was acknowledged before me
thisD.� day of t� 204_ by this day of 20_ by
(Name of person acknowledging} (Name of person acknowledging)
E
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ign Lure of Notary Publ -lriN—
State of Florida} (Signature of Notary Public-State of Florida}
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. �(sea(j l� N R Commission No. : (Seal)
"� IF�SHaKt4A ofFlor�da r
i �..r-� "� pubtic-Stat rc 20,241U
REVIEWS FRlp� Commiss; n FF 17� sn. (
�I f )oR-, PLANS VEGETATION SEA TURTLE ' MANGROVE
COU �4 , E ��11Urt ° ` E1W REVIEW REVIEW REVIEW, REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014