HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED r;AR 017017
OWN
LL 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: Q \ \) •
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Address: S CnCI'Aa/i L
Legal Description:
Property Tax ID#: 33��� 54 a^� �Oy3'4Q0- 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: ^ Right Side: Left Side:
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DETAILED DESCRIPTION OFWg$� RKY � '�y ° 'y
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C®N`STR'UC,TION,INF,®RMATI®N r1 ;
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Additional work to be pertormed under this permit-check all that appy:
_Mechanical _'Gas'Tank - =Gas Piping _Shutters _Windows/Doors
Electric Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: - Sq. Ft. of First Floor:
Cost of Construction:$ / dy Utilities: —Sewer —Septic Building Height:
011VNER/'LESSEE #� CONTRi4C'�OR: g �=
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Name k<
"�. , ' G a/�CacJ''` � Name:z6*
Address: X03 Company:"
City: L State: Address ?;7 93 Sr�.J- Gary f'
Zip Code: 3`f t�C p
Fax: City: I s L Stater
Phone No. ZZ�- �j6�- J's✓?3 Zip Code: 3 tf,93 Fax:77.I-207- ?Z Q
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License Cgt ct.71 9 2S
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
PPLEIfEN1AL CQNSTR.IJCTION LIEN LA11U INFORMATt
DESIGNER/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 aricl 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.
Signaturewner/Lessee/Contractor as Agent for Owner Signature of Co tractor/License Holder
STATE OF FLORIDA STATE OF . RIDA
COUNTY OF S-Nr. \.-y c %R, COUNTY OFV. C_
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this day of N'('%A-C 20� by this day of MM f .20AI by
)A a 4 �► OQ
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- ate of Florida ) (Signature of Notary Pu -State of Florida )
Personally Known OR Produced Identifications Personally Known OR Produced Identification
Type of Identification Type of Identificati
Produced �. Np, ARIEGNENS Produced 1► "�P D IE GIVENS
'••"''�'•� '= MY COMMISSION#GG 022023 = • = MY COMMISSION#GG 022023
Commission No. ecember16,2o20 =fir �
t � PublicUnderv+dters Commission No. 03� PIRES:Dn16,2020
6C+ O EXP
to ;F�,,,• ed l MU Notary Public Underwriters
Bonded N
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED.
DATE
COMPLETED
Rev. 7/2014