HomeMy WebLinkAboutBuilding Permit Application - I
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: ® Q
Permit Number: �3��
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w. v Building Permit Application
Planning and Development Services
Building and Code Regulation Division j
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR:
R �?QELI liVPRC}UMFNT L�'CATION
3 7 .
Address: ,
Legalescription: 2 C� C-1 - Y
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Property Tax 10 Lot No.
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Site Plan Name: ! Block No.
Project Name:
Setbacks Front Back:. Right Side: Left Side:
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Additional work to be pertormed under this permit=check all that appy:
_Mechanical Gas Tank' _Gas Piping _Shutters' : j'; _Windows/Doors,:
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft_of Construct'on: Sq. Ft. of;•First:Floor: '
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Cost of Construction:$ Qom': Utilities: Sewer _Septic Building Height:
oval / . ss .
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CC+NTRAGTOR
Name Pr I I Cc eV_ Name: 1A kl �'
Address: Company: 1 _
City: "4--, <--e State: Address:
Zip Code' C/ Fax: City: Stater
Phone No. �_ Zip Code: Fax:
E-Mail: ct 2 1 Phone N -4.'
Fill in fee simple itle Holder on next page.( if different E-Mail I
from the Owner listed above) State or County Lice se�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required
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SUPPLEIIlIENTAL CONSTRtCT[ON L
IEN LAW INQRM,4TIQN yo
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PP MORTGAGE COMPANY: _Not Applicable
DESIGNER/ENGINEER: 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 w rk or ,recording our Notice of Commencement.
Signature of Owr/'Le a/Contractor as Agent for Owner Signature of Con to License Holder
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STATE OF FLORIDA STATE OF FLORIDA Q�L �
COUNTY OF 4P__ COUNTY OF �T '
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_ by this day of 20_ by
(Name of person acknowled g) . (Nam of erson acknowledg',g
fPe'rsonally
tary ublic-State of Florida) na ur Public-State of Florida )
Known �P rtsedal�t�rtttf' t+ Personally Known OR Produced Identification
de ' n� dRY'p�L, ANGELA M HUFF P Type of Idend 's°`, ;`��; Notary Public State of Florida I' "" ANGELA M HUFF
SP GB�i
'. _ ;•= ommission# FF 234730 t Produced e ,* 0.YP��': e u is-State of Florida
"s;>" My Com Ex 'res May 27,2019!( _ b u•c Commissi g a 234730
Commission No. (+ ra Commission No. N *e �j
Banded th ��datior r tory Assn.it �ires�Aay 27,2019
Comm Ex
Bonded through National Notary Assn.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ke—v. 7/2014