HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��n
Date: Permit Number: ����' Mq
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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:
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;L O�POSED INPRQVEMENT LOCATIaN ir�� � A, x. k say . �`>, �. .� .f.
Address: of �� Sj 6�eY >I/E
Legal Description:
Property Tax ID#: 'L�? - 2 31"' D b Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right}Side: Left Side:
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C®`NSTRIJC-TI®N�INFORMATI®N � � � � q ,
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Additionalwork to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
j/Electric —Plumbing _Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
o c�
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
rOW �ESSEE�
Name/ an n i P 61'y %io Name-
Address:
ame:
Addresses3 3 ZZ S,ml>5� ,R)vd. Company:64,4 1-eSIr�
City: /'f- 4'i erlill State:fL- Address:- _�/ 9t,I iC/,ol �L,1E
Zip Code: 7 yyY Z Fax: City: State: F/4,
s
Phone No. Z f LZ 5 Zip Code: 3 q W2_1 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License 3D 0 b ZZ
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRpU'C1"IQN LI N LAW INFORMA OR,
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. 11
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 o Ow ontractor as Agent for Owner Signature o ont , ct r se Holder
STATE OF FLORIDASTATE OF FLORIDA ^(�� ^
COUNTY OF Q,�— (,Q,e.iov-e COUNTY OF `y Lu N e-
The f oing instr lent was acknowledg d efore me The for oing instr ent was acknowledge efore me
this- day of 20aby this day of 207yby
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(Name df person ack wle ing U (Name of pers n ackno dgi )
(Signar of Public State of Florida (Signature f o a ic-State of Florida )
CAS Y D F ENCH
Personally Known lr _o Pay P Pr�� � �n AS�jq ft Personally Known, _ _ O�R,P,roduced�dentifieation,-�_
Type of Id ifi a '`jrr. ti �° _ m. r D c 1,2017 Type of Ide tific ti�„„,,, AS, Y FRENCH
Produced F�069924 Produced Ki � v '� o I'�f S, t�of Florida
, ° ° til Comm.Expires Dec 1,2017
B n Pd Through Natlonpi Notary Assn. �'=
Commission No. �/ Sea7j "� Commission No. rl CommissiorS no69924
e onded Through aonFiNotary y Assil.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014