HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: iOT, 1� Permit Number:'n
._ .. ...........--------------------- Building Mw . Building Permit ApROi IE®
Planning and Development Services
Building and Code Regulation Division OCT 3 1 217
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)4.62=1578 Commercial lRne
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PERMIT APPLICATION FOR: G St. Lucie Coun y,
PRtPQSED INPROUEMENT LOCATION
Address:,5- e-7-2 r°
Legal Description:LfO I/ �L�e/ �� /�,�s � � �� L i l L l S/nx.
Property TaxID#: � �a� 5da " c�di�� ddd�� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIQN OF WC►RK: T
� ..
e
1 Ir s
�_. .� .aI_QNH I-N'_FO. R. MACNCONSTRUCTe
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Additional work to be pertormed unclerthis permit-check 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:$ Utilities: —Sewer _Septic Building Height:
GINNER/LESSEE CONTRACTORS'
Y
Name Ul �i�(�iU�e�-- Name: I
Address: 5 -7 b 3 'C(r Company:
City: d State: Address:
Zip Code: � Fax:�r, City: State:
Phone No. c� j �S 1. Zip Code: 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
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPE?I:EMENIAL CaNSTRUCTfON f.fEN LAW INFC?RIVIATfQN.
s�
DESIGNER/ENGINEER: _Not,Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: --- - __ - __ ____ ____ State: City: State:
Zip: Fho,ne Zip: Phone:
FEE SIMPLE TITLE HOLDER:`` `_'Not Applicable BONDING COMPANY: Not Applicable
Name:
Name:
Address: -''' Address:
City: _ City:
Zip: Phone:" '''i'''' 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 ur Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent r Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S COUNTY OF
The forgoing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this-.25N day of a20by this day of .20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary.Public tate of Florida) (Signature of Notary Public-State of Florida)
Personally Known ORPrProduce l - fiqti:cartp Personally Known OR Produced Identification
Typeof Identifi D, DEANNMIARIEGNENS Type of Identification
Produced � . °° _ „� �,�s N#ee022023 Produced
Y EXPIRES:December 16,2020
Commission No. e 7hNrfotUY l ti6ewiters Commission No. (Seal)
REVIEWS' FRONT' ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW` REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014