HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INt MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O
Date: � I Permit Number:
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:
PROPQSED INRROUE,MENT LF9CATI®'N:
Address: 1�g' �G �4_e41' ,U 7/vo . /VoKxn
Legal Description:
Property Tax ID#: ~ / / Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DWEII WE PJDWN IIPATI I®'N O OR
if All I
G.FG% Q,;X . i22^ w P F ✓h u ( rz,PA I PJ/ie-g
CON5TRUCT0190 INFOR+MATION:
Additional wor to be performed under this permit-check all that apply:.,
7M chanical Gas.Tank _Gas Piping _Shutters _Windows/Doors
y
_Electric _Plumbing —,Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ' J 0,0�0.o o Utilities: —Sewer —Septic Building Height:
QWNERESSEE: CONTRAC 0
Name Name: I1,0616 -
Addre rt _: Company: � , �oc�•F / 'G
Ll�
City: `t' L% State: Address: /b31w S' �e19 �i�
Zip Code: Fax: City: A S .L_ State: FL
Phone No. Zip Code: VSa- Fax:
E-Mail: Phone No 7 7 2 a Y-6 3 ,2
Fill in fee simple Title Holder on next page (if different E-Mail JwL a u (ou(44 opi-e -t7u�c 0.001
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 CONSTRUCTIbN LIEN LAW NFO ' MAT10'
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 ailo#her n'on-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 recordin , our Notice of Commencement.
Sig of Owner/L /Contractor as Agent for.Owner Sign at Contractor/ ' se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 'COUNTY OF
The f ping instru t was acknowledged efore me The forgoing instrume it was acknowledge before me
this day of 20��y this lay of 20� y
z 1 ��
( 'ame of person acknow dging) (Name of erson acknowle i g)
) (Signature of Notar ublic-State of Florida
(Signature of Nota Public-State of Florida )
Personally Known OR Produced Identification Personally Known Irodentification
Type of Identif„i,c4(6n' ,, . Type of Identif'cation.
Produced aY Produced .." Not? qN F q'
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Otaf F ' °%oaf oaO�° °/n b CC SM HUFF
« Y Public State of dd ,,,, „ /(?y Cfi1g tate°
Commissiotj `� «Y,c commission#FF23lq�u Commission,No. :, �8c°fifi f�@ kFp3rFlor/da
oF FLo,o` mm.Expires may ^ _ hr°u es M.y 30
dt PIr 4I
"" Bonded through Natio Y 27 20J9
9l'Nati°qat a ?�20
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REVIEWS FRONT ZONING, SUPERVISOR PLANS VEGETATION SEA TURTLE MAN son
kAIVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW, REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014