HomeMy WebLinkAboutMap All APPLICABLE I FO MUAT BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
1:1111111211111112 1111111Y_N�V 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:
PROPOSED INPROUEMENT LOCATIQN
Address: -3 in 3 r3 Pio,o ee(- C I r
Legal Description: �10 _J cl z 060 e,
Property Tax ID#: A (D � (� � d!�_ ~ C) 0 d _Z Lot No.
Site Plan Name: Block No.
Project Name: 1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OFWORK ,i
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i-CONSTRUCTION INFORMATION
77
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Additional work to a per Orme un er this permit—c ec a that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:}
Cost of Construction: $ �g Da Utilities: _Sewer Septic Building Height:
R
r r
OWNER/LESSEE CONTRACTOR fi
Name Dd"'� ►A", Name: oi,. 14"(-J
Address: Po-3aq 2(9 Company: 0,t Sty, �`t�t E�e c:��n ctiorcr �P/'✓
City: F6�� eta i'�e- t✓ State:_ Address: lob SW 4 V�� d P_
Zip Code: 33 Fax: City: PST P State:
Phone No. Zip Code: 01.1 Q►5 3 Fax:
E-Mail: Phone No — 5. I ?
Fill in fee simple Title Holder on next page ( if different E-Mail S yvM 1-r
from the Owner listed above) State or County Licensetlrgt3b M�7)
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
MIISUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
`
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 thepermit 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 our Notice of Commencement.
Al
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA ll T
COUNTY OF / 9�C'_(-P� COUNTY OF
The for oing instrume was acknowledged before me The for ping instru ent was (Lt before me
this: ay of 20��by this ay of 20 by
(Name of person acknowledging) (Name of person acknowledJ�L�� M ging)
V I
Signature Notary Public-State of Florida ) (Signa ure of Notary ublic-State of Florida)
III Wally Known OR Produced Id nt' nation ersonally Know"`" R� d e tification
T of�denxifica ' z P _ . . T
ANGELA M HUFF �': ANGELA M HUFF
�; - �= Notary Public-
Produced,•''���P '' Produced :� • ° �4\)A = P state o
n- �?- state orida f Florida
,r�� Commission#FF 234730
> Commission#FF 234730 '� ="=ifs
lti.pv.` FY fres May 27 ®�� Commission No °' t'�y Comm•ExpirgS 13 2019
Commission °:z Prsemm r(L Y ( ). nrn;„; 1
Bonded through National Notary Assn.
2
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.