HomeMy WebLinkAboutBuilding Permit Application II I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO-BE ACCEPTED
Date: �� Permit 1 Number: �'f
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Building Permit 'AppliCati
'on
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort-Pierce FL 34952
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Y
Address: d l x1or ✓ �/• -V'� �i 3 915—
Legal Description:
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Property Tax ID#: a 6 f 6 z 10A z-Y06C,51 Lot No.
Site Plan Name: Block No.
Project Name:
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Setbacks Front Back: Right Side: Left Side: 11
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Additional work to be pertormed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors 1
Electric _Plumbing _Sprinklers _Ge erator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction:$ 3 d Utilities: —Sewer Septic Building Height:
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a m e 41t Jga O Name:
Address: C,5''01 Jlloe�-I_ /, j✓� Company:
City: f, e V c-e— State: Address:
Zip Code:J3 ra, Z Fax: City: III State:
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Phone No. �' Y;0G�,S`8' 0 Zip Code: '' Fax:
E-Mail:rrlcr1 /// Y ( 0r/4-4,1. C01q Phone No III
Fill in fee simple Title Holder on next page(if different E-Mail III
from the Owner listed above) State or Coty License
If value of construction is 2500 or more,a RECORDED Notice of Comme ement" .required.
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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-
ddress: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 recording our Notice of Commencement.
Signature ofOwner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA �� FLORIDA
COUNTY OFCOUNTYA �G
The forgoing'instrument ws acknowled efore me The forgoing instrument was acknowledged before me
this 3 day of 2110 by this day of .20_ by
( merson acknowledging) (Name of person acknowledging)
(Signature of Nota rVoublic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification IV Personally Known OR Produced Identification
Type of Iden Type of Identification
Produced 'P ANGELA HUFF Produced
Public-State of Florida
Commission -'' *'= Commission#[5(Mh)730 Commission No. (Seal)
;.F °p�� y omm.Expires May 27,2019'
'° Bonded through National Notary Assn.u"
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v.7/2014