HomeMy WebLinkAboutBuilding Permit Applicationr . -;r,
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCANT NFW4'
Address- 6 o!* r -'s P"a 1�' P, b
Legal Description:
Property Tax I D 404- vo--- ooi-7 —000--7 Lot No. 7
Site Plan Name:mr'w Block No.
Project Name: S 1\ fc—
Setbacks Front Back: Right Side- Left Side:
DETAILED DESCRIPTION OF WORK'
Krfc61�j CJTL6-f_S FC P-, &F W C11 g Ai F_ 7-
W> LWMR, cA&;AJET 1_(GW_1d6-
CONSTRUCTION INFORMATION.
Additional work to be pertormed under this permit - check ail tIlU app y:
11HVAC 01 Gas Tank F]Gas Piping 0 Shutters F]Windows/Doors
gElectric ElPlumbing OSprinkiers 1:1 Generator O -Roof
Total Sq. Ft of Construction: S. f First Floor:
0
Cost of Construction: $ 7_� 0 utilities:11 Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:-:
NameName: EA)GF_i_MftAJV
Address: qd AuTu,,,i b A P company: A-CC04-IF16 6_ae-7410-1 C01OWCT/A4, .Ale
City: S LWGEK_A ribS State: Address: ?173 Qi(OTe( Pi -
Zip Code: t oq 151 Fax- City- Fo'A:r Si Lane if_ -state: F
Phone No. 779- F% 7 Zip Code: -3 q �57a Fax:
E -Mail: Phone No. 77a- 370 -9'756'
Fill In fee simple Title Holder on next page ( if different E -Mail: bc V.P,4wH ( A rr, AJf: —1
from the Owner listed above) State or County License- C- C 0 0 0 -,z- 0 7,
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone:
EEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not
State:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
BONDING COMPANY: —Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the worts and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit -
St. Lucie County mattes 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 firs inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin ' ork or cording your Notice of Commenceme
-- �
Signature of O er/ Agant/ lessee Signature oontra-c—tor/License Holder
STATE OF LORIDA D STATE OF FLORIDA . '
COUNTY OF 14 COUNTY SOF ,
The for Ding instrument was cknowledged before me
this day of t220JJ by
(Name erscsn acknowl ing )
(Signature of NotaryZu�b�licState of�
ZO`f��/rjrf/'/
^y y ... l ...
Personally Known OR P�4'n
Type of Identification Produced = f �0 �o
Fla
Commission No.
)
��s'99 :rah'Pob�Iic�' ?f�1
REVIEWS FRONT ZONA +iii ERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED --
DATE
COMPLETED
Rev. 7/2014 - -
The forgoing instrument was acknowledged before me
this _L day of , 20JZby
-ter e
(Name of person ackn� oGdledging )
(Signature of Notary Public-Se of F1
�N i
A16E C. I//§, 'NIX
Personally Known OR Pr
Type of identification duceO-" !163, berr
dao gyp' ^:
Commission No. =� �(gealj't";
`0 L FF 098192 =
PLANS VEGETATION SE',6( r,t►V+\A`�'JIANGROVE
REVIEW REVIEW REVI REVIEW