HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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:
PRQPOSED INPRQVEMEIVT LQCATIQrNY„ ' „
Address:
Legal Description: D d fr- ztz� Au oY' 3 l=j O )
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Property Tax ID#: fir/ 9 - .�'4�.�� 6[L QCT - (> Lot No.
Site Plan Name: XL%p•fe &, e-7 Block No.
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Project Name:
Setbacks Front Back: Right Side: Left Side:
` DETAILED DESCRIPTION QFWORK
ST,r. D&C V6-
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CC.ISTRUCTtON INFORMATION Vis. ',-�'
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Additional work to a per orme . under this permit-c ec a tat appy: �I
_Mechanical _Gas Tantk` -Gas Piping _Shutters' _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 6-4000 Utilities: _Sewer 2septic Building Height:
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OWN ER%LESSEE x - C TRACTOR '
Name.,/�C E%� �-r R�. Na e AV �P!G!�
Address:. /S” /� I Co pany: Sr-5-
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r5 i y: 7Z,C.) State:,t�G. Address:�oT70 6S'/" 5r •� -
Zip Code: 3 Fax: /- y�- �� City: 01-4 s2 State: FL
Phone No. t /� 695--/4V// Zip Code: 33V*7 it Fax:
E-Mail: D�R. &Wuq, (2 ho .C, Phone No SG!- o%-,2-X6-Y:57'
Fill in fee simple Title Holder on next page(if different E-Mail SPce4-- %c22V Ci vcCG6ou7-6, /
from the Owner listed above) State or County License CGG O`flj97
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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StlPPLEMENTAL CONSTRSIJCI"I®N LIEN LAb1flV IN'F®RIIVlATI. .N: mom
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 acid 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 r an attorney before
commencirw work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner nat a of Contract r/License Holder
STATE OF FLORIDA ATE OF FLORIDA
COUNTY OF 'Pitlrn 04ae '1 COUNTY OF RA inn 2,7e6LGII)
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2.2- day of 15":h 201,-7 by this 2�&day of Sip 1- 1201-1 by
(Name of person acknowledging) (Name of person acknowledging)
�,;�i k/v
i nature of Notary Public-,State of Florida) (Sig a)re of Notary_ Public-State of Florida)
Personally Known ......�. Pro uc 0$i� on Personally Known V QR.P.ijq, uce eg H SSEI�
6' Type of Identification '�°P `' Nolar
Type of Identificat' rrz� •`� Notary Public-State of Florida y Public-State of Florida
Produced =•: :•_ Commi inn # GG 055554
Produced • �: _- nmission #GG 055554
FF My Comm. Expires Apr 9,ZO2 �,FOFFI�'A MY Comm.Expires Apr 9,2021
Commission No. """""• Bonded Ihrou Sbafl nal Notar Assn. Commission No. "' "' - Bonded {,
y National Notary Assn.
1110
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014
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