HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: "l Permit Number: b
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:
PR 1111 NPROUEMENT LOCATI`CtN:
Address: 2-6z- 6 i K'I i i D%
Legal Description: 6ord IC., o v e Fetich ` e - one — Pln /of % (os#q-
Property
Tax ID #: ! �Z - ` 7(% I - 005 - 000 - % Lot No. 1 7
Site Plan Name: Block No. 3
Project Name:
.r.
Setbacks Front Back: Right Side: Left Side:
TKtell neew /Covtde�tjmy to (f Servl'c-e 3o,-, 7- L10 Volf west 5i de.ef
C d r a el .e , R e r� ce d r y Coyt e c SGjj r C d k cl . 41� rl c tiJ f Gr .0 h, ,p.:'cyl g Co h d-
1.4 blit ZO. ZOO V 4 Site 15 f hOW5-e , A I,/-.- I
pe
_Mechanical Gas Tank
�lectric _ Plumbing
permit - cnecK an mat apply:
Gas Piping _ Shutters Windows/Doors ,
Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:Sq. Ft. of First.Floor: ;. •;
Cost of Construction: $ Utilities: _Sewer Septic Building Heiht:
OWNER/LE�S�-SES:
, CONTRAC`fOR:
Name cT L jVv e,
Name: ®otK P1,KR `..'
Company: Piyle Flectri C � _rt1c�
Address: �-'GZi3,' mt &6 Pr.
City: r-4-- I"tt�� �`arce State: FG
Zip Code: 3 if � Fax:
Address: eo Do, I Z 9•SJR
SI
City: Ff, / e'vee State:
Phone No. 9 S Lf z 5 7- 000
Zip Code: 3�I ql 7 9 Fax:
E -Mail:
Phone No . % 7 Z ' �Z 9'. qY(Y7
Fill in fee simple Title Holder on next page ( if different
E -Mail
State or County License R-001063
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEM NTAL CONST �!U'CTION LIEN LAUV 1NFORMATIQN'
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DESIGNER/ENGINEER': _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City:
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 recording your Notice of Commencement.
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Signa re of Owner/ Lessee/Agen -
Signature of Contractor/License Ider
I
STATE OF FLORID �1 n
`C�
STATE OF FLORIDA I
COUNTY OF yL.
COUNTY OF
The for 6jng instru ent was -acknowledged before me
thi 20!
The f oing instrum t was ack! owledge�efore me
this day 201 by
ay of jDy
of
C.
(Name of person acknowledging)
aN\�'e tvw AQ..f I I
(Name of person ackno ledging )
a,,,, ':t
(Signature of No ary Public- State bf Florida)
(Signature of N ryTPublic- State of Florida )
Personally Known OR Produced (dentification
Personally Known OR Produced Identification
T ' -
Type of I en�ti#�r2a '
t GELA H F
;$
Produce
y ��a '�s� Notary Public
1 _• « * •_ Commission # FF 234730
fi (Seal)
I
-State of F
Commissi . * •' Commiss' # �I
r aF: Comm Expires May 97 2013;
IF 234 Q
"I s oma.
OF Fl�•�
,, Bon ±, d lhmuqh F : ;, .,i ., j n
x , oP y COMM.E y , 2013 y
'',,9 �„1,`'� Expires May 27
Bonded through
Nati i }, . ,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014