HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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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:
P. 11 RKORNAMR R I DI I1N2ROVE W 1ENITS L®CATI'lei N:
Address: A (en?/ -5� 1/soVetl DA
Legal Description: e.51Y;51e.5 Xxe zJ&1AL6 ie zSlaa.��
Property Tax ID #: AF � � 7 - 7 -d eOO % -0U� `' l Lot No.
Site Plan Name: Block No.
Project Name: 10
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION F W®R+K:
e e,, 410 e. ,ted
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CONSTRIJCTlO'N NF®'RMATION:
Additionalwork to be pertormed under this permit— check all that appy:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing Sprinklers Generator _ Roof Pitch
_ _
do
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $/tea Utilities: Sewer Septic Building Height:
OW' .ER LESSEE;
CONTRAC M
Name:
Name ✓»A/ ��e�'I'� 5
Address: i 'l JL°.
Company:
Address:
City: - 411I, �F/ /, 42 State4F
Zip Code: '11W �71JU Fax:
City: State:
Phone No. ��� �� $"' �6 �/
Zip Code: Fax:
E-Mail: do
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Ma'
from the Owner listed above)
to or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
M
SIJP'RLEMENTAL C®NSTR[JCTI,ON LIEN LAW INF®RlMATI®N:
MORTGAGE COMPANY: _ Not Applicable
DESIGNER/ENGINEER: _ 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
rnmmcnr%Aa %Ainrlr nr rarnrrlina vnur NntirP of rnmmPnrPmPnt.
ev. 7/2014
gature o�0_ w-naer/, Le ee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID► ` `
STATE OF FLORIDA
—
COUNTY OF U c1A -Q .
COUNTY OF
The f rgoing instrum t was acknowledge efore me
this' day of CW, 20_L/by
The forgoing instrument was acknowledged before me
this day of 20_ by
•� l-,R('ur
(Name of person acknowledgi )
(Name of person acknowledging )
(Si tu(e of N t ry Public- State of Florida)
ignature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Iden i 'c do ,,,,,,,,,, ANGELA M HUFF
^Type of Identification
Produced
Produced oto"Oa;%,_ Notary Public -.State of Florida
=' * •_ Commission FF 234730
Commission No.a°o' MY dk)Expires May 27, 2018
Commission No. (Seal)
���"'� Bonded through National Notary
REVIEWS
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ZONING
SUPERVISOR
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014