HomeMy WebLinkAboutBuilding Permit Application i
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All APPLICABLE INFOI MU7 BEC MPLETED FOR APPLICATION TO BE ACCEPTED
Date:
`� Permit Number: ' r7
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{ . - 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:
P.R;OOOSE0 INPROVEMEN �
T LOCATION
Address: 1
Legal Description:
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Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks . Front Back: Right Side: Left Side:
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DETAILEDDESCRIPTION OF WORK
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CONSTRUCTION IN QRMATION
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Additional work to be per orme un er t is permit cfi-e—ck all that appy: !
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric _Plumbing _Sprinklers _Generator ._Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1,OOCO Utilities: —Sewer . —Septic `j Building Height:
OWNER/LESSEE CONTRACTOR.
Name >
Address:�1 '` '�0�5 Company: Ulmtt
City: )-State:_ Address: Wl7Z 1 MC SG Lan-e-
Zip Code: — City: State:EL'
Phone No. 'Zr Zip Code: "--,N Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License X301 S I sa O
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRIlCT1N LIEN LAW tNFQ.R11/IATlQN
.. ., . .. ./ - _ppl- MORTGAGE COMPANY: o bl
DESIGNER ENGINEER: Not Applicable 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, 1 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 ' spection. If you intend to obtain financing, consult with er or an attorney before
comment. ork orrecording our Notice of Commencement.
00ZI -111o/'1--�<11"oo,
,-i� r of 0 ner/Lesse ontractor as Agent for Owner Sig urle f ntract r/License der
STATE OF FLORI TATE OF FLORIDA '
COUNTY OF VLC� COUNTY OF —�� C.`�
The forgping instru t was acknowledged before me The f r oing instrument was acknowled a efore me
this ay of 20by this ay of �20��by
VQ�O_A P, C� �_M 4,
(Name of person acknowledging) (Name ot person acknowledging)
(Signature of Nota ublic-State of Florida) (Signature of Notary P f,
ic-State of Florida)
Personally Known OR Prod ced Identificati:7, Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced ANGE6n A�u„GF
ANGELA M HUFF
ti ,`aYP �,,;, of Florida ?°, «o= No Public-State of Florida
Commission Not .`b�P s Notary Public (§ 9� Commission” .�* #FF 2J5_a1)
* ; Commission# 34730 Commission"
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M Comm.Expires May 27,2015: 5� Nq) -- «Oz; My Comm.Expires May 27,2015 u
�''';of F 1- gnndedthrouQh National Notary As
r '4F OF F��`` Bo ded throng� aut,•;;ei��,.�,;;,'.::"
REVIEWSRONT' 'ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev. 7/2014