HomeMy WebLinkAboutBuilding Permit Application 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 >e.
PERMIT APPLICATION FOR:
PROPOSE®`INPROVEMENTLO,CyA1Tliv` rtk Fg';
Address: 2410'r Av vaL r" DY -rcmr Alen-Az Fl �✓ �4�Z
Legal Description: 41e Cw.4.,7.6E= 0a7
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CONST RUCT{ONINL=ORMATION T � �
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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: $Tqf� Utilities: -Sewer _Septic Building Height:
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301NVER/ ESSEE ��` ,. CONTRACTOR ; ��
Name Name: w
Address: 2 .Os O m• Company: 6eaAM. 916e-AY•e_
City: State: Address: I'W S' 716"
Zip Code: 349 SP2 Fax: City: Stater
Phone No. V,60) 707-• -W951• Zip Code: Fax:
E-Mail: Phone No��2'Z
Fill in fee simple Title Holder on next page(if different E-Mail 6g
from the Owner listed above) State or/county License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ,
SUiPPLEIt/.IjENI"�AL C�#N(a��S�}TRtJCTI®N LIEN L�►W INF®R�MA�QN,:
r}Y?
DESIGNER/ENGIN EM ' _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
commencing work or recordi our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF `T I'uuz COUNTY OF ��
The forgoing instrum nt wad cknowledged before me The forgoing instrume t was acknowledged before me
this 0� day of ��V 20� by this `�2 day of /� v i l 20 by
�VC �_ F>ti `�l D V O�l� �l �✓ �`—���\1.� w
(Name of pe n cknowledging) (Name of person ac nowledging)
(Signature of NotaryJPublic-State of Florida) (Signature of Notaryic-State of Florida)
Personally Known „w9.9,ProducedlD56rfFt:0fiVh Personally Known I "I '?traduced Id@@fifKffi ir40
Type of Identificatio �'a�;�Y U;` = Notary Public-State of F on Type of Identification =_; °n"=? Notary Public-State of Florida
Produced ' ° Commission#FF 184850 produced =,'; 'e Commission#FF 184850
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' °�F��� Bond h tlonalNotaryAssn.
Commission No. '° Bondedth` h atlonalNotaryAssn. Commission No. — _
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE .
COMPLETED
Rev. 7 4