HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO ' UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
+L 6
Date: �.� I Permit Number: ' COY
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 G/
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT,LCCATIUN ;, ..
c
Address: O C
Legal Description:
Property Tax ID#: ('� 2 O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE5ICRIPTION QF WORK
47E,- C
CA-) .7771
'
CONSTRUCTION INFORMATION... _ ,
�
Additional work to be pertorme under this permit—check all that appy:
J 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: $ C' Utilities: —Sewer _Septic Building Height:.
OWNER/LE 5EE CONTRACTOR '
_..
Name ( Name:
Address: CC C V v Company: — S 1C4 14
City: -e �l/ C— State: Address: '—� ZV tXJ
Zip Code: Fax: City: S —p Stater
Phone No. �� �f -� Zip Code: O 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 d
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN (?R1VIA710N �
/ pp MORTGAGE
DESIGNER ENGINEER: Not Applicable
�ablINEe 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 thepermit 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
comm,e.ocing work or recording our Notice of Commencement.
r
Signature of Owner/Lessee/Contractor as Agent—for-6—wrier Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA r
COUNTY OF �L�G� COUNTY OF
The forgoing instrument was acknowledged before me The fprgoing instru Len was cknowledged before me
thisl-day of 20B by this 1day of 200 by
co r*'\a�k_�
(Name of pe son acknowledging) (Name of person acknowledging)
a a"M "
" Im J , -
(Signature of Notary Public-State of Florida ) (Signature of Not y Public-5 -e of Florida )
Persona lly'Kh-b b u ed d tification Personally Known ��OR Produced Identification
Type of 1 11" tJ1T1 ���b A M HUFF Type of Ide if c
�" '2* +of No / bIIG-$ Produced lokyPo°'' AN L
Produced? � f Florida o e� FF
+ '2 mmission#FF 234730 e io tate of Florida
F`O fJly Comm.Expires may Commission#FF 2g
Commissio'^ )
Commissi, n I �p Y( �g15 F xpires May 7,P019
ug i National Notary Assn. °`"°' f,.
=;r _ "' Bonded through Nat1ional Nota Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 014