HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �(� -�^ 17 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:
PROPOSED1NPROUEM'ENIT]
LOCA ICON;
Address: 2_ 0 Y N, �ta S S
Legal Description: �v 1 L ot/K/f= I h i� !v Lo / dLl 4 ,o L_0 TJ�
d- Z f fig (O -2_5 U
Property Tax ID#: Ztt0 g- 60)- 006.71-00d-1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DfTA1=LED DEQ CR+121011 F W�ORRK: u
Re-dfiee 150 A mefelre-dn , JnJCJtid groujiJ.`vif S-!f:Ff-eM domstied by
W rr ane-
C0 I STRLICI'ION Jill
Additionalwork to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: .. Sq. Ft.of First Floor:
Cost of Construction: $ � Utilities: —Sewer _Septic* Building Height:
®WNfR/LE�S�SEE: ' CON�RAC�T®,R,;
Name L-et4/ I S' 1• f{dr>» ,`Soil Name: Pall Pole
Address: X300 EUt?gree)i oye Company: Piave FjeCtrc
City: Ft- Pte(reQ State: ISL Address: Fa box J2gg'
Zip Code: 3 q g 1t7 Fax: City: f::+, P;e►ree State: F�
Phone No._M- ��9-f?Z�6 Zip Code: 3 q?79 Fax:
E-Mail: Phone No ZZ Z- q7- 9-9R97
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License . FA 00I 5'3 63
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPP'LEMENT.�L C®NST a UCTIDN :LI,'N .LAW L . 'ORMATIQ
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 recording our Notice of Commencement.
_,b� Au
Signa re of Owner/Lessee/ gent Signa re of Contract r/Licens Holder
STATE OF FLORIDA c� ����� STATE OF COUNTY OF FLORIDA � �
COUNTY OF J 1
Th f rgoing i, _ ent as acknowledge before me The forgoing instru�rtent was acknowledge efore me
thi day c 201 by this D,day of 20 y
Can
(Name of person acknowledging) (Name of person acknowl dging)
� r I
(Sigtu>sof tary Public-State of Florida nkWevof N ay Public-State of Florid )
Person llt =Rrudletcation ersonally Kno OR Produced Identification
ANGELA M HUFF >
Type of Idem" on NN Type of
2°. *c=; Notary Public-State of Florida ANGELA M HUFF
Produced a - 30 ? Produce .,,����,
FF S
?2° i`�:; Notary'Public-State of Florida I;
A? =9, My Cornm.Expires May 27 �01 k C• - _ Y
Commissi�r� °•' g ,,,•,,•, dal)" p �1� •_ Commission FF 23470 I'a
Commissi
onal Notar ,.,: y -N r •a
i�-,_..�_.,...,_._T•- ,` IJIy Cornm. xpires May 27,20�;;$
,,� Bended through National Noiary Assn. r'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
` COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014