HomeMy WebLinkAboutBuilding Permit Application I I
All APPLICABLE INFO MUST BE COMPLETED
,FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:,i f 7(13-()Jo
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 i Residential
PERMIT APPLICATION FOR:
PRQPOSED INP O ERRETL(?CAT110,
Address: 661c) f,)A L� Qe\ r)VT R�e ('Li. :-�Z- �C495-
Legal
5-Le al Descri tion:��► 42-M, e.
2 i i
Property Tax ID#: �J�1-(�l� raise- DOD 7 Lot No.
Site Plan Name: Block No.
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Project Name: I.
Setbacks Front Back: Right Side: Left Side: l
D TAlI.ED DESCRIP IIS' �'RK:
new y0 rak
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ON5T UCT M .FOR)1/IAT ON.
Additional work to be pefformed under this permit—check all that appy:
_Mechanical -Gas Tank _Gas Piping _Shutteri Windows/Doors
I
_Electric ✓ plumbing _Sprinklers _Generator ! _Roof Pitch.
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Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 5M,Q D Utilities: _Sewer _Septic j' Building Height:
'E /LEbSS E CIONRAC57
Name'V('}C -Rr'o\ \e-5 Name:c�p1��k IL
Address:IOn['°% v`r� e✓Her c� Company:�{�e �. 47U 1� Y ` Iliw.�trs LLC-
City;,_ v Avg' ' State�C� Address: ? I, fiber
Zip Code:3q �q 1-/ Fax: City:-t A- Vi e-Cue—, State:�C�
a hone No._17,9 — 361— 3veZVJ Zip Code: 3V9 Fax:
E-Mail: Phone No _ 7d�—,?L1,�—C41"D L)(e7
Fill in fee simple Title Holder on next page (if different E-Mail h�� ��-���f [C G � y 1D�00 �Cc�
from the Owner listed above) State or County License C FC%lqo? -to
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ,I
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IJ'PPL C ST w CTl`®N L;ESN W I' i ®RMATIO
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 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
cprfflMerKinF,work oy-xeqcirding your Notice of Commencement.
1
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aSig ure of Ow �
ner/Lesse tractor as Agent for Owner Sig ure`of Contractor/License Ider
TE OF FLORIDA c1 _. 'STATE OF FLORI A �.
COUNTY OF �" COUNTY OF
The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this3- day of - 20� by this day of M(xW,h ,20 11 by
J4 0
(Name Aperson acknowle ing) (Name of person acknowledge )
( ' ahire of Notary Public-State of Florida) (Signature of Notar ublic-State of Florida)
Personally Known - OR Produced Identification - I Personally Known OR Produced Identification
Type of Identification {� Type of Identification t
Produced AHNp 1NGRcA1 piorida Produced ' QA—
%Q-
01 U Zp18 q GATSIN FEDE
up o@� s° N TARY PUBLIC
°�P"r'OB��',-, Notary Public-es Dec 2
Commission No. =� •°: y comomir,FF 177249 Commission No. �Q
•► ommiss%on otary ass°' _ W,_•z. TATE OF FLORIDA
C htou9h National. e COmm#;G.G066420
•,r r:
of Aires 25/2029
REVIEWS FR ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.7/2014