HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
s - r
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:
PRQ`P®SE� INPR®1/fM�EI' LOCAT'I'ON:
Address: 1 l (n lot 1�i 0 i 0 RQo�s Df -
Legal Description: 1 i)t' n (�P S �- G-c 1�- �G in , OR 4Q�-d8(60
I . b >aO1 C& 8-7 ( — akaA1
Property Tax ID#: -- tool cots- <:G(D- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:-----------------
'
DETAILED DESCRI�PTIO�N QF U1/OR°K: � ,
e
CO'NSTRtJCTION I�NiF®IMIIT ®N: }
Additional work to be performed under this permit-check all that a.pp y
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �� Utilities: —Sewer _Septic, Building Height:
Name n+ Name:
Address: 1 UoVo:l -TL tfN 32 Dak5 [)2 - Company:
City: Pie.RCo- State: l- Address:
Zip Code: 34qA-E; Fax: City: State:
Phone No. -- Q- - Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State &5 my License
If value of construction is 2500 or more,a RECORDED Notice of Commen ment is required.
SU"P'PLEMENI"AL CONS1"R<l1CRTI.ON LIEN L 1W 11 i-41RaMI®.N:
W
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 reco otice of Commencement.
Signature of Owner/Lessee/Contractor as Agent or Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The f r oing instrum nt was acknowled a efore me The forgoing instrument was acknowledged before me
this..day of 20 by this day of 20_ by
OA—A c�_aQL-h lzz'�K
(Name of er on ackno ledging) (Name of person acknowledging)
(Signature of N lbyPublic-State of Florida) gnature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced Produced
Commissi n A=LA M Ny�-�Sea Commission No. (Seal)
ML
Notary P0116 X Wfe 64 F1809
09
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4 y9s `v� 'myyY2^/
REVIEWS bpti$�1RQJ�ITi,���,;iQla}JGr��j UPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
-'C0`UNTER°`r•=-R�E'•VlfWg. REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014