HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLL�E\11 ST MPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 6 I
I
0
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: To Select from dropbox, click arrow at the en'
d of line
PROPOSED IIVIPRbVEIVIENT.LO:CATION
Address: A� 3 1 's-i- �, fi
Legal Description: 5F U`i'nnr 6� DAf' �`� ' V n,,���� In
7
Property Tax ID#: '3 150 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
j
DETAILED DES'CRIPTI IN'.OF WORK > ,'
cc)V\ rr C bV 'mk"� �aIV�
S t 3
CONSTRUCTION INFORM°ATIQ_N
Additional wor tob e pertormed under tis permit-checkk all apply: I
HVAC Gas Tank ❑Gas Piping _ShuttersQ Windows/Doors
I
Psi
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ / `T( ,l� Utilities. _Sewer Septic Building Height:
011UNER/LESS.EE
CONTRACTOR••:
Name b`r I'lo ' Name:
Address: '5-1 _ Company:TLlL
City: CC���(/CSL State:_ Address: O
Zip Code., D4q 5 k Fax: City: V1 �i State: t
�22--_ ` -gs- RLVI p ;iN8 Z Fax:��7
Phone No. Zi Code:
� _
E-Mail: Phone No. - ��� g
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
!I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.''
�I
l
SUPP.LEMENTALCONSTRUGTION,LIEN LAW IN:FORMATIO,N ,
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: II _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone: .I
'I
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do thelwork 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 Amendmel lnts.
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 o'r an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner essee/Contractor as Agent for Owner Signatun,cif Contractor/Liceri'se-Holder
I
STATE OFRIDA _ STATE OF FLORIDA '
COUNTY OF COUNTY OF
I��
The f r oing instr nt wa acknowledge re me The fgrgoing instrur nt was'acknowledggbefore me
this ay of 20T this y of V 20 by
-)-�l moZ' ��!LLL — �-30UM � -Q
me rson king statement a erson making statement
son R Produced Identification sonally Known OR Produced Identification
ype of Identificattion i a 1 '
Produced Produced
C��e M it Ii
1 ILJ — M
(Signa re - to a of Florida) (Signature of N ry Public-;State of Florida)
111111111// �.—t��..e. •I• - �
`'1,1�PRva ANGELA M HU
P ��eal)
F ANGELA M HUFF Seal `' """
Comm ssi ri Notary ( ) z Commissiofi� ' `°�^',
_ &--State of Flonda <. ;a°m Notary u lic State of Florida
COmmiss 0n#FF a t
M 23473C is u .• Commission# FF 234730
1 FF111)` ` Y Comm.Expires PAaY 27 .;,1 -"a° `oma: v " Expires Mai 27 2015 '
I//I 11111
'9 ahonatNotaryAssn %°L��'� Bond! through National Notary ssn.j
REVIEWS FRONT ZON9TV6 SUPERVISOR PLANS `•hLEGE'T%aT10N GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ji REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17