HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�o��� 1�1 Permit Number:
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RECEI'. 7 217
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: ®
PxROPOSE`DINPROVEMENTLOCA IpN �: � � a �? ��
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Address:
Legal Description: J.v��-s ,rl 6.7�
Property Tax ID#: 03 e DOS - oco- 7__ Lot No.
Site Plan Name: X L7LX / O
A) _3 � Block No
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Project Name: - / , 0k'q ��
Setbacks Front Back: Right Side: Left Side:
DETAILED�SC�tIPTION OF=WORK ,
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Additional work to be pertormed under this permit-cneCK all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $4 AC2C2 � Utilities: _Sewer _Septic Building Height:
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OWNERjLESSEE '�� k' � "CONTRACT ��
Hr"^ k
Name ehe le- ,l i6�.�'� Nam Y h. / ..�
Address: IVI"a S ` 4.zo Company: oljyy� S5
City: E &'d State:�'c- Address: SSI C',
Zip Code: Fax: City: State:
Phone No. y �� &,/ Zip Code: Fax:-71Z•
E-Mai1:lf9f A.Y0 Co�6l Phone No
Fill in fee simple;Title Holder'on next page (if different 'E-Mail ES% oa �� '�
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- 'from the Owner listl.ed, :abo o)' State or County License 27`
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJiPPLEMENT. L CONS�TRU TION LLEN LAW INF®RMATlON: MIKE I M
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 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 recordJing your Notice of Commence t.
Si&n`atvUrevof Owner/Less e ntractor as Xgent for Owner Signa Contractor/License Holder
STATE OF FLORIPA STATE OF FLORIDA
n�
COUNTY OF Gi COUNTY OF /1 l 4,4
The f rgoing instrument was acknowledge�efore me The f r oing instrum t was acknowledged before me
thisday of 20/ by this day of 20LI by
rGf?P��c� AIV A-
a 0�'�1 J1I� �Jb
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rson acknowledging) Mf per ack o [edging)
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LA—R6_� Q�� I a"
/(Sig ature of Notary ublic-State of Florida) ign tur`e of Notary Public-State oTVCrida)
Personally KnownProduced Identification Personally Known OR Produced Identification
Type of IdentificatioX__� Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED Notary Public State of bride
Lisa Greer ts arath
DATE a Lisa Gr e r Bharath n a CoQ My Commission FF 96 709
COMPLETED MY Com ssion FF 962709 NILof r�P Expires 02/18/2020
Rev. 0