HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �030
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, -Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial Residential
PERMIT APPLICATION FOR:
PROPO;;ED INP OVEMENT LOCATION:
.r i 1 / f !? ✓1 P � i .nJl /./% �' / /% �! ' s,�-_ � ae it a r „_.�
Address: /LZ12 0"
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/_X /�/�zr / .Y zIN - 046LEIv
Legal Description: &�e=_
A/.a//ritl
-L�G2�� 744'el
,- G0X
City: /Cif /�/��_ State: f4i_-
Address:
Property Tax ID #: 0 0 Lot No. �-
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
G
Aaaitionai worK to ne perrormea unser tnis permit- cnecK an tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
d -c
Cost of Construction: $.�--
Sq. Ft. of First Floor:
Utilities: _ Sewer T eptic Building Height:
OWNER/LE�S�SEE:
CONTRALTO
Name /env�r�� C®v, .
Name:
Address: ly4e�
Company:
City: /Cif /�/��_ State: f4i_-
Address:
ZipCode: fi Fax:
City:
State: d"-�e__
Phone No.
Zip Code:
Fax:
E -Mail:
Phone No 7717--Z-1114
—/-71G
Fill in fee simple Title Holder on next page ( if different
E -Mail e, 01��
sie62Gvo ccr�z,
from the Owner listed above)
State or County License C65--l's-1
91;1a i
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SIJF'PLEMENTAL CONSTRUCTIOW@ 1-fi-IN LAW IiNF®RSMATI'O'N:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: 15hone 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
bef re the first inspection. If you intend to obtain financing, consult with lender or an attorney before
co m ncin ,work or recording our Notice of Commencement.
Signature of wner Lessee/Contractor as Agent f wner
Signatur o;tra for/License Holder
FLORIDA.
STATE OF FLORIDA—
STATE OF FLORIDA('- f
COUNTY OF CUCI
COUNTY OF —' �A ��
The fong�oing instru . nt w s acknowledg Id before me
a by
The f oing inst ument was acknowledg before me
this day of 201by
this day of 20j7
60sche
(Name of person a 'nowledging)
(Name of person ackn wl dging )
(Signature o Notary Public- State of Florida)
(Signature of Not Pu lic- State of Florida )
Personally Known OR Produced Identification
Personally Known' OR Produced Identification
Type of Identification
e of-Ider�ti#tca
Produced t +5 (.IC �o''- NANCY HERRERA
P duced - q ELA M HUFF
Notary Public - State of Flor
` �I mm. Expires Oct 5, ?_
Commission No. ( p
da IPRY P�B'�y �,c
1;C mmission No. =2°. o`r's Notary Pu�j tate of Florida
- Commis5 ona FF 234730 ��
F�QP' o mission # FF 049374
IIS' Bonded Through National Notary A
iN * ti°� My Comm. Expires May 27, 2019 +
sn. '%lF. o? 1
,
REVIEWS FRONT ZONING, SUPERVISOR
r
PLANS VEGETA I N SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2-014