HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO�MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ^���� / Permit Number: 1670-5 05 3
TIP WIT—
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Building Permit Application
Planning and Development Services MAY 1 $. 201
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: ot
PRO '®SED INPRO�IEMENT LOCATI(J�N:
Address:41C JtO) De- r, t o �o T A
'k c z FL
Legal Description:
Property Tax ID#: 313o 6,0�- 6 650 Lot No.
Site Plan Name: Block No.
Project Name: ���+✓ Vll .,' 7 JL
etbacks Front Back:�� , Right Side: Left Side: <
DETAIL 1D D S >'FTIO ®; OR
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CONSI'RUCTI N INFO } ATION:
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters =Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof, Pitch
Total Sq. Ft of Construction: I'ot� Sq. Ft.of First Floor:
Cost of Construction: $ � '� (�� Utilities: —Sewer ,_Septic Building Height:
ORMIRS ER/LE�S�-SEE: SON RACTO'R:
Name _ -A cc.,-Xe S glct m n - Name: �7
S '
Address: o�� a v Company:
o�
City: Far4 Sfete �L Address:. : ; �,,;�(_ 01z
Zip Code: I c{9 5-\ Fax: City:
Phone No. Z`\- 33' ( Zip Code:
E-Mail: �d'c�vcl a (0`5 e� R� .r.�►r1 Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or county Litense
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU!PPLEME�NTAL CONSTR-UC1'lON LIEN .LA INFORMAT(0'N.
DESIGNER/ENGINEER- Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: t 9 S _� , ►1 e� Name:
Address: ( ) 6 �e ��n Address:
City: (, `G of . State: 6 iC City: State:
Zip: fi2! oC1 Phone U 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 onithe 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.
SiTat -o /`Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF tSN-. COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�5 day of 20AI by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P blit-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced; �� --= � Produced
.•0•Y iUpb DEANNA MARIE GIVENS
Commission No. o MycoMMc�rt�#GG022o23 Commission No. (Seal)
EXPIRES: ece�Sbet 16,2.020
Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014