HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: -1c
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
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow atlthe end of line
PRf��SED IMPROUEMENT`LOCATION A
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Address: 11 (05' S, JAJL)J�Ji\1
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Legal Description:
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Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: ®e L62
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Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK ` , � 4 � � �� � :�. ��r `
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J00A-MP D(3CK 9- UYICE Ok) P�>fllSr7L, WIKE L-1 -7- a�opS Epp
(OF DOC k0VIQE 3-10VMT Gr-T- 9ECETIC'LES roP. GeAJ94-4L
USE, L,) f Ke L0U VoO—A-GE, LIGHTS A IJ-b sN 1� �IGi-I T
CONSTRUCTION INFORMATION r - r
itiona wor to e e orme un er t is permit—c ec a appy:
HVAC OGasTank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers []Generator EI]Roofl
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ ���Q Utilities:Sewer Septic i,Building Height:
OWNER/LESSEE k a t o- t CONTRACTOR r
Name k®1=N Name: Agi40r_ 6&�GELvnfiUnl
Address: Cd b 1 A LiEXA-K)b CIS, Company: &C0f_ft1-r6 6).AEC740- COIJAACrinla� ,aC
City: r-1- 190'er✓ State: FL Address: '?173 6010-Ti Pi-
Zip Code: 349$a Fax: City: AKT STI L.ue16 State: FL
Phone No. 77,�_— gSa– 1X48
`) Zip Code: 3 4 1$oZ Fax:
E-Mail: Phone No. 77a.i 370,-677x6
Fill In fee simple Title Holder on next page(if different E-Mail: LSC Vp..t"eiCH NC 1
from the Owner listed above) State or County License: fx C080907a
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ' �;,Not Applicable
Name: Name: I
Address: Address:
Ci State: City: I State:
Zip: Phone: Zip:
Phone: 1'
FEE SIMPLE TITLE HOLDER: Not:Applicable BONDING COMPANY: Not Applicable
Name: Name: I
Address: Address: i
City: City: I
Zip: Phone: Zip: Phone:
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OWNER/CONTRACTOR AFFIDVIT:.Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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,l 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 ndn-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
commencW work or reeifiding your Notice of Commencement.
Signature of Own /Agent/Lessee Signature of Co tractor/License Holder
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STATE OF FL IDA STATE OF LORI
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acikngwledged before me
this day of .20 by this/3day of `77f&--L.4 L-;20/7by
(Name of person acknowledging) {Name of pe n acknowledgi g}
(Signature of Notary Public-State of Florida} (Signature of Notary Public-Sta
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Personally Known OR Produced Identification Personally Known a� �ca�3=n
Type of Identification Produced Type of Identification Produ edi:�, a
Commission No. (Seal) Commission No. 4ga1 eal�o
s Ic SCA
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
eV.
7/2014