HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: moi- � V, T_. I -I Permit Number:
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:
PROPOSED INPROVEMENT LOCATION:
Address: ':a +_ '
Legal Description:
Property Tax ID #: ISC)4 [ t 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1c.1 IZi.= u I C' Int
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit – check all that appy:
�'IGlechanical _ Gas Tank _ Gas Piping — Shutters Windows/Doors
Electric _ Plumbing Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ Vi oc. . cc -
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE,:
CONTRACTOR:
Name '_ _k..f � "�G` 1f (� t`
Name. �� ,a:. l f l
'ir , ci C.I. V
Address: i �; �i d� I ---I C�t k®,
Company -0 i\\ f
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Address: U C- C'_ �'C'
X ►` _ (- � '+
City: cc, State: _g-
Zip Code: 3zAC —AC`4 Fax:
City: f 0 i �' Ce
State: "
Phone No. 4 __-)4- t),2 C
Zip Code:
Phone No "� L I- C, c E
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E -Mail: �s "�L �:',1 "lC ► (. [, ; ,L ..�}
Fill in fee simple Title Holderon next page if different
E-Mail_:t'. L i t `%
(L (i3 'i ,► °� C:,
State or County 'License C vVic. { r`S I1 cic r
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
MI
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
comrnencinta work or recordinia vour Notice of Commencement.
IlCr
Signature o0ontractor/Licen5&al er
Signatur f Owner/ Lesske3C tractor as Agent for Owner
STATE OF '
FLORIDA:4 G
s
STATE OF FLORIDA 1 !
� 1
COUNTY OF �3-
COUNTY OF 1��
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this I2` 7day of �_ ry -t-� 20}M by
this day of i1� 20{�7 by
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(�
(Name of persdn acknowledging)
(Dame of person a knowledging )
fI '/
p�'
P
(Signature of Notary Pu ic)tate of Florida j
(Signature of Notary Pubi "e of Florida )
Personally Kncilvn OR ProcIvAL I.Aptification _
Personally Known OR Produced Identification
Type of ldentifi6at` i�,V
Produced n = Notary Public Skate of Florida
Type of Identifltjca
produced
= es Feb 9. 2418
�o Commission el FF 083522
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Commission Na _ --- �(.ealj--
- Notary Public - 5t iS�i�k} ; i a +
Commission NO ' » _ d
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i F� i �: + omm. Expires Feb ji.
9, 2Q18 � r
Commission # FF 08352
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
R'ev/2014